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REVIEWING A MANIFEST
<br /> REVISE EL MANIFIESTO
<br /> Verify this is your Store's EPA ID#
<br /> Verify this is your Store's Verifique su EPA ID#
<br /> Address and Contact Info Manifest#
<br /> Verifique su direcci6n e 9W or typ.I�—6.9.d bvUOr ,s Fa o.+era 2050-M
<br /> 0�.aao _,,,,,d , �,,, Manifiesto#
<br /> informaci6n de contacto ",,,,,,"Fes' 'C A R 0 0 0 1 2 3 4 5 6 1 (air)678-M0060 4841 JJK
<br /> so..,c..ww.a,rwe.es.w Exemplar#746B .sw.er.w,raw.wa..rN.aaw,
<br /> Attention:Gary Haywood 810 East St
<br /> R (415)244-1146 San Francisco,CA 94134 Emergency
<br /> Transporter Name - EEmlimi msntel8olutbee M N s 0 0 0 1 0 0 9 2 4 Response Phone
<br /> and EPA ID 1Cv°°'^"� 0S awww (make certain one is listed)
<br /> Telefono de respuesta
<br /> (make certain there Acme Recycling B Disposal us UACN~ ante Emergencias
<br /> is an entry) 8520 Way Lane
<br /> Nombre del trans ortador ,� (e75)4247215 Ads",GA 30019 G A D 0 0 0 1 2 8 9 7 e
<br /> p Disposal Facility
<br /> y EPA ID w ° °'°p�om°n"w.sncaaw.w�aa�,uwm.. �acsv :i:>r xw
<br /> ,.. .,,,„ '�`+�-�- and EPA ID
<br /> I
<br /> UN1t#50,Waste Aerosols,ptwmnabie)2.1,PG,ERCr128 (make certain one
<br /> An "X"or"RQ" is listed)
<br /> indicates there is—F1 UN1993,Waste Flamnuelelliq",nes (ethanot,methano43. Centro de disposici6n y
<br /> DOT Hazardous X PG It,ERG-128 EPA ID
<br /> MaterialUN1760.Waste Conova llcpft.n.os. (sodium r n ;
<br /> X sodium saNcate)8,PG Il,ERG•154
<br /> Una "X" o "RQ"
<br /> indicaN •H
<br /> que hay , e7mdoua,Nen-R� "1'�� 561 Make certain EPA
<br /> materiales peligrosos ,.sewwdh ,• -
<br /> •t=+• or State Waste
<br /> 1 5.94 Codes are Listed
<br /> Confirme que el
<br /> Proper Shipping Isoe,sn oasarelOReCatlMGmpkreweyadslrlrarwdnaoaprstn/yn nveyeroa.l.mreyMpoprMlppnnrtlnaWapw�p.4 EPA o los c6di os
<br /> ...awNe..atr..+.arw.er�.mwaawmarat...ca�wewwrrrrwrwarr w.•r+warra.s.wndew.i.e,ee.ee.wr 9
<br /> Description Area de residuos esten
<br /> r..ar..ti.r.r+r.ar...�a.erewaae�nwle�...ww.ee mni,. awwu«,�wrnya,.
<br /> (must be filled in) enunciados
<br /> Area de descripci6n — L�7 L
<br /> del envio(debe ser �»❑"ponb9' ❑�°°"""' �" Stericycle
<br /> completa) 1➢a n knwre�wdtlew+Wd,rw. ;�;, Representative
<br /> i4
<br /> D. Name&Signature
<br /> rvw wmn rw
<br /> Transporter Name (to be signed once
<br /> and Signature I 140um.wgw*-5a E]a„d ❑T", ��,, ❑pyo ❑��,, manifest is reviewed
<br /> (Required prior to I and information
<br /> a..a
<br /> departure from ,� rw,.ia�.�wa, us ria wro. confirmed)
<br /> your store) „� � Nombre y firma
<br /> Nombre del =.tl ta0.wwd aa. - del representante de
<br /> trdnSpOrtddor y firma ww:wanw.a.s.pawngw.s+adrooCod,V.,,m.br.m,,.ww„dw..,.w..,.„-�e,,.,o..
<br /> Stericycle
<br /> OwwraeMrWrfitlr✓rstlawpdw.rra.rra.. wart—rsaw
<br /> Disposal Facility sof ILegend:
<br /> Name&Signature EwI!9 °a"`w va ,•�a:.,. . t.... ,..,
<br /> (included on final copy Items to Verify
<br /> received approximately Informaci6n para
<br /> NOTE:Store MUST place copy left by tech in the Hazardous Waste Program file,once the verificar
<br /> 30 days after service) product has been disposed of. Final copy will be mailed to store. The Final copy of the
<br /> Nombre y firma del manifest MUST BE PLACED IN THE FILE,as this is the copy the Inspector will ask to • Signature Required
<br /> centro de disposici6n review.If you do NOT have the final copy for the Inspector,immediately call Stericycle Firma requerida
<br /> 800.815.3770 to have it emailed to the store to prevent your store from being fined.
<br /> The Stericycle Guide to Potentially Hazardous Material Management •�• Steri eye I e°
<br /> Gula de Stericycle Sobre el Manejo de Materiales Potentcialmente Peligrosos
<br /> Environmental Solutions
<br /> ©2017 Stericycle,Inc.All rights reserved. DC 1 LBR01-02-0417
<br /> Bad i&BodyWoft
<br /> 1x1LBR01-02-0417.indd 9 4/25/2017 3:02:31 PM
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