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Please print or type. Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1' iF 9240309901 2.Pape 1 of 3.E� y)Rey sy Pt 69 4.Manifest Tracking Number WASTE MANIFEST I 1 1 014403158 F L E 5.Generator's Name and Mailing Add,% C end On 1 v #264 Generator's Site Address(if dif19 tVWVi ad NI V#264 (209) 478-2133 1449 W March Ln 1449 W. March Lane Stockton. CA 95207-6111 Stockton, CA 95207-6111 Generator's Phone: 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 Mot, LLC U.S.EPA ID Number 11855 White Rock Road Rancho Cordova, CA 95742 Facility's Phone: 9163510980 0884183 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.IVol. X1 UN1950. Waste Aerosols. [flammable. (each not 1 DF 00097 P 214 D001 exceeding 1 L capacity)) (Aerosols). 2. 1. ERG#126 LLJ Z 2. UJ 3. 4, 14.Special Handling Instructions and Additional Information 1. 101998(Aerosols) 15. GENERATOR'SIOFFEROR'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 tatement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or b)(if am a small qu ntity enerator)is true. Generator'slOfferor's Printed/Typed Na a Signature Month Day Year 01AL 2T 201 $ 11XV _j16.Internationa Shipme s ❑Imp to U.S. ❑Export from U. Po of entrylexit: ? Transporter signature(for exports only): Date leaving U.S.: 17.Transporter Acknowledgment of Receipt of Materials Transporter 1 Printed/Typed Name Signature Mont 0 Da, Yeeaar o 20 Johnny Harper 20 0CL I Z Transporter 2 Printed/Typed Name Sign e Month Day Year H 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: � 18b.Alternate Facility(or Generator) U.S.EPA ID Number J U LL Facility's Phone: w 18c.Signature of Alternate Facility(or Generator) Month Day Year a Z v519.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 0 1, H \w T 3. 4. 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted 18a Printed Typed Name r Signature Month Day Year TID YY1 C� z� t,,,-' I S1 U 11n, EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. DES'IG ATED FACILI EPA's e-MANIFEST SYSTIAM 8700-2212v3 CAL40000139 540028331 041758005 M PD042720 SD042720