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� I 1111 I IIIlllllllllll IIII11111111 Please print or type. E R l Form Approved.OMB No.2454-4439 UNIFORM HAZARDOUS 1.GeneratorID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Trackin Number WASTE MANIFEST CAL000363835 1 (877) 577-2669 016�5 2203 F L E 5.Generator's Name and Mailing Address Generator`s Site Address{if different than mailinaddress 99 Cents Only #1 .57 99 Cents �Inly 157 (209) 339 -9103 300 W Kettlesan Ln 300 1 Kettleman Lane Generator's Phone: Lodi CA 95240-5740 Lodi CA 95240-5740 6.Transporter 1 Company Name U.S.EPA ID Number Clean Earth Soecialty Waste Solutions 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 Raab , Rancho Cordova, CA 95742 � Facility's Phone:C3 I 111 ga 91 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. X IJN1950, Waste Aerosols, [flammable. (each nos: 1 ---F 00004 p 214 Dli exceeding 1 L capacity) ] (Aerosols), 2. 1, " w ERG z. �. 3. I I 4, E 14.Special Handling Instructions and Additional Information e r 0 S 0 1 S) 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 labeledlplacarded,and are in all respects in proper condition for transport according to applicable intematlonaltional ernmental regulations.If export shipment and(am the Primary Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowietlgment of Co en1. I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b) am as I anti generator)is true. P.Intem.atZiokal�hipffienlls r edlTypjN1j. Signature Q `�9 Cents QTIIy Month Day "ear 10 07 2021 F ❑import to U.S. Export from U.S. Aktof entvri. Z Transporter signature(for exports only): eav' gU. Ljj� 17,Transporter Acknowledgment of Receipt of Materials Transporter 1 PrmiedrTyped Name Signature Month Day Year a Darryl Johnson 10 0712021 X Transporter 2 PrintedlTyped Name Signature Month Day Year 18 Discrepancy 18a.Discrepancy indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number 18b.Altemate Facllity(or Generator)26 F AA U.S.EPA I Number � A y >L acuity's Phone: Cl W 18c.Signature of Alternate Facility(or Generator) Month Day Year a �. �- /D Z3 Z N19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) Q 1' 2. 3. 4. 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item i8a PrintedfTyped Name Signature Month Day Year EPA Form 6704-22(Rev.12-17) Previous editions are obsolete. DESIGNATED FACILITY TO EPA's e TEM 8700-2212v3 CAL.40000139 540028246 042189077 M PD100721 SDIO0721