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Please print or We.(Form designed for use on elite(12-pitch) pevailer.) Form Approved,OMB No.2050-0039 UNIFORM HAZAROOUS I,Generator ID Number 2 Page 10l 3.Emergency Response Pham 4.Manllaet Tracking NumberWASTE MANIFEST 008117674 JJ K S.Generators Name and MWkgAddresre r s(NdiRerenl than mdlmg address) J R Simplot Company 16777 Howland Road Genraato tatnr re a: 35330 USA iCA 6.TanspMa 1 Com U.S.FPAID Number 7.Tmnspwtw2 Compwq Nsme U.S.EPAID Number r 6.Delig mad Facility Name and SAeAddreaa - U.S.ERAID Number U.S.Ecology Corp. phfT3,a0D1rJL0rj Highway 95-12 Miles Souln of Beatty Beatty.NV MM Foc1i s Phoma: 9a. Mo U.S.DOT Desaipfiert(,dudrg Proper Shipping Nemo,Hazard Class,ID Number10.Cardaham it.Total 12.unit HM and Peam-9 Gaup ManY)) top. Type Ouan6ty W Wnl. 13.Waste Codes 1, o X UP13?60,waste CorrosNe Solitl,Aol01o,Inorganic, iJ.r0.5. (Soil,OeGrla J Ch1 i/.A "V Conlaralnated with SuINRC Acid),6,PG 111 Z Z. UU c7 4. III J 14.Special Handrng b abuc6em and Additional InWmelion Cain #- g72�I Dilfard Project x 3397-002 _ g.a.1 (pt 070176917-0 . 15. GENERATOR'SIOFFEROR'S CERTIFICATION:I hereby declare that Mecantenh of this consignment are fully wall accurately desctbed above by en proper shipping name,and are dassifee,packaged, marked and labeledlplamrded,and are in a0 respects In propermon@on for banspottacmrdmgto applicable mtemafwtal and national go mmmental regulations.Nexpod shipment and I am the Primary Exporter,I ca*that thecontents of this camignmed comfort to the tarts W Ne attached EPAAckuwladgmem of Consent. I candy Nat the waste minkntratlon statement Identified In 40 CFR 252.27(a)IN I an a large guamNy,generator)or(b)(d I am a small quantitygenaramr)Is no. Gensurstoes/C ps s PrialediTyped Name sgnnum Monty Day Yeaz r 16.ntemagonal Snnpmenis F- ❑Import to U.S. ❑EpoM1 form U.S. Potlaf enayladC z Transporter sgnalum(for exports only): leadng U.S.: w 17.TrensponaA6amwf pmtof Remptofmaedals - y�. Tmrepmler 7 PnnledRyped Name SignaNre Montle Day Year O ti to / Transporter 2 Pdte ntedrTyped Nay SgnaWm vMurat OeY Yaa ♦ 18.Dlsvepaary 18a.Dlsuapan ndcagon Stam ❑ Operrov ❑Type ❑Resdw ❑Partial Repollon ❑Full Refection Manifest Reference Nanbar, 1 ab.Alternate Facility(or Generator) - r U.S.EPAIDNumber U LL FeaWs Phan: 10c SignonaeofAttemam Fadity(er Generator) kwmtn Day Year a z y19.Hazardous Waste Report Management Method Codes l.e.,codesfor hazardous waste treatment dispdsat and recydhil systems) WI. :� 2 a a. 4. 20.Designated FavTlty Amer or Opemar.Cedlmcaon of reasO of hvacou mmadets m me,!by me me best except as nosed In Nem t an 1 PdMedrryped Name Slgnalwe Month Day Year EPA Form 87DO-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED)