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ER Please print or type. Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST CAL000369901 1 (877) 577-26690156304,42 L E 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) 99 Cents Only #264 99 Cents Only#264 (209) 478-2133 1449 W March Ln 1449 W. March Lane Generator's Phone: Stockton, CA 95207-6111 Stockton, CA 95207_-6111 - 6.Transporter 1 Company Name U.S.EPA ID Number Stericycle Specialty Waste Solutions Inc MNS000110924 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address General Environmental Mgt, LLC U.S.EPA ID Number 11855 White Rock Road Rancho Cordova, CA 95742 Facility's Phone: 9163510980 CAD980884,183 ga 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes HM and Packing Group(if any)) No, Type Quantity Wt.Nol. X1 UN1950, Waste Aerosols, [flammable, (each not 1 HA 00005 P 214 D00 --o -- exceeding- 1--L eapae-ity4l---(Aereso-l-sY 2 1, ERG#126. z 2. L 0 3. 4. 14.Special Handling Instructions and Additional Information ,1.PKG-DF•101998:(Ae ro s o l s) 15. GENERATOR'S/OFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, marked and labeled/placarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations.If export shipment and I am the Primary Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(ff I am a small quantity generator)is true. Generatoes/Offeroes Printed/Typed Name Signature[lie -a o Cents On 1 y Month Day Year 16.International Shipments t V1 r- ❑Import to U.S. ❑Export from U.S. Port of entrylexit: ? Transporter signature(for exports only): Date leaving U.S.: it w 17.Transporter Acknowledgment of Receipt of Materials Transporter 1 PrintedlTyped Name Signature Month Day Year a Jeff Hawilton Z Transporter 2 Printed/Typed Name Signature Y Month Day Year t- 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: F� 18b.Alternate Facility(or Generator) U.S.EPA ID Number AV el w 18c.Sign re of Alternate Facility(or Gener Mon Day Year Qvt__ 41z N19.Hazardous Waste Report nag ent M od Codes(i.e.,cod o-hazardous waste treatment,disposal,and recycling systems) 0 1. 2. 3. 4. 1 20.Design ed Facility(54er or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Printed/Typed Name Signature Month Day Year EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM