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- -- - ���I �� <br /> Please print or type. Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator fI?N.rrmber 2.Page 1 of 3.Fme gency Response Phone 4.Manifest Tracking Number C <br /> 1NASTE MANIFFS7 CAL000369901 1 (877) 577--266'9 015630444 1 LE <br /> 5.Genera&s Name and Malting Address Generator's Site Address(if dfP,erent than mating address) <br /> S9 Gents Only #264 99 Cents Only#264 <br /> (209) 478 .2133 1449 W March Ln 1449 W. March Lane <br /> Generatoi's Phone: Stockton, GA 95207-6111 - Stockton, CA 95207-6111 <br /> 6,Transporter 1 Company Name U.S.EPA ID Nunter <br /> Stericycle Specialty Waste Solutions Inc MNSOOOI10924 <br /> 7.Transporter 2 Company Name U,S.EPA ID Number <br /> Worldwide Recovery Systems CAR000175422 <br /> 8.Designated Fac ll( ;Name and&te Address YUMa. Yes, LEU U.S.EPA 1D Number <br /> 2730 E. 13th Street <br /> Yuma, AZ 85365 <br /> Fodlity`s Phone: 9286428938 AZ 8000515924 <br /> 9a. Sb.U.S.DOT Description(in-dudbg Proper Shlpp]ng Name,Hazard Class,ID Number, 10.Containers 11,Tmtal 12.Unlf 13.1haste Codes <br /> HM and Packing Group(if any)) <br /> No. Type Quantity V'1t1Vol. <br /> '• Non RCRA hazardous waste, liquid (Consumer, 1 DF 00049 A 33� <br /> o Products), <br /> � 2 <br /> LU <br /> cta <br /> 3. <br /> 4. <br /> 14.Special Harx.+ling Instructions andAdditional Information 1. 101990(CA State Regulated Liquids) <br /> 15. GENERATOR`S'OFFERAR'S CERTSWION: I hereby declare that the conten's of this consignment are fuCy and accurately described above by the proper shipping name,and are classified,packaged, <br /> marked and W)dedlplacatded,and one In all respocts in proper coition for transport according to appitcabla International and national governmental regulations.it export stpment and I am the Primary <br /> Exporter,I cerTy that the contents of ttes consignment conform to the terns of the attached EPAAck notvtedgment of Consent <br /> I certify tftat the ttasta minimszatlon statamant identified In 40 CFR 262.27(a)(d I am a large quarr6ty generator)oA(b(dl am a small q,,,arntity generator)Is true. <br /> Genaratoft[Dfferor' PAntedlTyped Nana Signatm-e a of 919 Gents Only Month Day Year ff- %�u 0_�_ I /so 1 <br /> 011 1q 20"3 <br /> 16.Infsmadonal Shipments <br /> r— <br /> E]Import to U.S. ❑Exp ort from U.S. Port of entrylexrt <br /> z Transporter signature(far exports only}: Date leaving U.S.: <br /> = 11,Transporter Ackrnowdedgmeot of Receipt of Natefials <br /> LLIa Transpen�t 1 Pri n�dffyped Name Sign h'.onth Day Y ar <br /> Q Jeff.HaMilton A0 1 2021 <br /> aTran:sportar2PrinfedlTypad Name�-Y�iLL�'�-� 5ignah!rn tA/m�ralh Day Year <br /> tr r�yst i/ <br /> 18.Discrepancy <br /> 18a.Discropanq hd;f.Lation Space Quandt {�-� <br /> Y ❑Type ❑Reslrkra 1J <br /> ❑PartialRojeclion Fvf{RojecGon <br /> htanRest Reference Number: <br /> �} 18b.AltemafeFacitily(or Generator) U.S.EPA ID Number <br /> .ra <br /> L9 <br /> tar- Faci6tys Phone: <br /> LLj18c.Signa ure of A tomate Fac Sty(or Cerarator) Month Day Year <br /> Q <br /> z <br /> 19,Hazardous Waste Report Management Method Codes(i,e.,codes for hazardous wasia treatrwrit,disposal,and recycling systarrns) <br /> r� <br /> 1. l r LI 2 3. <br /> k. <br /> 20.Designated Fac ity Owner or Opera or.Cerd§catfon of receipt of hazardous materials covered by the manifest except as Td in Rem 18a <br /> PrintedltypedName _ $�tyre t onll Day Ye r <br /> 2 <br /> EPA Form 8730-22(Rev.i -77) Previous editions are obsolete. qDESIGNA CILITY TO EPA's e-MANWEST SYSTEM <br />