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ER <br /> Please print or type. Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.GCAL00@369835 2.Page 1 of 3.E`ereg�cyj es o��Pho�n .9 11,Manbsig ir�tyy�r 9 <br /> 88 WASTE MANIFEST 1 U�Lj� 1/ F L E <br /> 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) <br /> 99 Cents Only #157 99 Cents Only#157 <br /> (209) 339-9103 300 W Kettleman Ln 300 W. Kettleman Lane <br /> Lodi. CA 95240-5740 Lodi. CA 95240-5740 <br /> Generator's Phone: <br /> U.S.EPA ID Number <br /> 6.Transporter 1 Company Name <br /> Stericvcle Specialty Waste Solutions Inc MNS000110924 <br /> 7.Transporter piny Name �( �{;G�-- <br /> U.S.EPA ID Number <br /> /L1 �_ ` <br /> 8.Designated Facility Name and Site Address 21st Uentury EMN. LLL U.S.EPA ID Number <br /> 2095 Newlands Dr. East <br /> Fernley, NV 89408 <br /> Facility's Phone: 7755752760 NVD980895338 <br /> ga 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11,Total 12,Unit 13.Waste Codes <br /> HM and Packing Group(if any)) No. Type Quantity Wt.Nol. <br /> X1 UN1993. Waste. Flammable liquids. n.o. s. DF 6009111 P 33 1 DM <br /> o (Petroleum Distillates. Alcohol), 3. PG II. <br /> ERG#128 <br /> Z A 2. UN281 1. Waste toxic so 1 s. organic. n. o. s. <br /> 0 (Pvrethroids). 6. 1, PG II. ERG#154 <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional 1. 101992(Flammable Liquids) . 101985(TOxi8 Solids) <br /> 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, <br /> 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 <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I arp small quantity generator)is true. <br /> Signature e a Lents n V Month Day Year <br /> Generator'slOfferor's Printed/Typed Na 1 0 20 <br /> 16.International Shipment Import to U.S. ❑Export from U.S. `j Port of ntrylexit: <br /> i= Date leaving U.S.: <br /> ? Transporter signature(for exports only): <br /> W 17.Transporter Acknowledgment of Receipt of Materials <br /> LLI <br /> Transporter 1 PrintedlTyped Name Signature Month Day Year <br /> o Johnny Haroer 1 0 20 0 <br /> L Month Day Year <br /> Transporter 2 Prin Name Signature <br /> Z �- LU <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication SpaceQuantity Type El Residue ❑Partial Rejection ❑Full Rejection <br /> ❑ ❑ <br /> Manifest Reference Number: <br /> U.S.EPA ID Number <br /> F 18b,Alternate Facility(or Generator) <br /> J_ <br /> V <br /> LL Facility's Phone: Month Day Year <br /> W 18c.Signature of Alternate Facility(or Generator) <br /> Q <br /> Z <br /> CD 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> D 1' 2' 3. 4. <br /> Desi Hated Facilit Owner or Operator:Certification of receipt of hazards materials covered by the manifest except noted in Item 18a <br /> 20 g y MonthDay Year <br /> Printed/Typed Name c Signature <br /> —601 <br /> fc)�L Y TO EPA's e-MANOIFEST SYSTEM <br /> 12 <br /> EPA Form 8700-22(Rev.12-17) Previous edl ions are obsolete. DESIG <br /> 8700-2212v3 CAL40000139 540028246 041892680 M <br /> PD100220 0100220 <br />