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Please print or type. (Form designed for use on elite (12 -pitch) typewriter.) & (e ,Q (n l.I- Al S( > QT Form Approved. CMB No.2000-0406. Expires 731 86 <br />Style F15-6 Labelmaster, Chicago, IL 60646 EPA Form 6711(1-22 (3-84) <br />0� <br />UNIFORM HAZARDOUS <br />21. Generators US EPA ID No. Manifest Document No. <br />2 <br />Page 1 <br />Information in the shaded areas <br />I <br />WASTE MANIFEST <br />CAD 063547996 10001 <br />of <br />is not required by Federal law. <br />3. <br />Generators Name and Mailing Address <br />A. <br />State Manifest Document Number <br />Stampco Inc./Bulk Transportation, Inc. <br />3032 El Dorado <br />A <br />6. <br />State Generators ID <br />4. <br />Generators hone 2$`206466-0481 <br />CAD 063547996 <br />S. <br />Transporter 1 Company Name 6. US EPA ID Number <br />C. <br />State Transporters ID 809111 8 <br />Stampco Inc. I CAD 063547996 <br />D. <br />Transporters Phone 408 268-1196 <br />7. <br />Transporter 2 Company Name 8. US EPA ID Number <br />E. <br />State Transporters ID <br />F. <br />Transporters Phone <br />9. <br />Designated Facility Name and Site Address 10. US EPA ID Number <br />G. <br />State Facility's ID <br />Enviro Safe Services of Idaho <br />10.5 miles N/W of Grandview IDD 073114654 <br />H. <br />Facility's Phone <br />Grandview, Idaho 83624 <br />208 08 —834-2275 <br />12. Containers <br />13. <br />14. <br />I. <br />11. <br />US DOT Description (Including Proper Shipping Name, Hazard Class and ID Number) <br />Total <br />Unit <br />Waste No. <br />a <br />No. <br />Type <br />Quantity <br />WtN01 <br />N <br />a. <br />California Regulated Waste Only <br />n <br />ORM E NA 9189 - DOT Unregulated Waste <br />2 <br />DT <br />0020 <br />CY <br />611 <br />A <br />T <br />b. <br />0 <br />R <br />C. <br />d. <br />J. Additional Descriptions for Materials Listed Above K. <br />Handling Codes for Wastes Listed Above <br />Contaminated Soil With Diesel Waste Stream <br />Load Must Be Tarped <br />#0322SX <br />V' e • <br />15. <br />Special Handling Instructions and Additional Information <br />AUG 1 U 1,087 <br />EN <br />R <br />16. <br />GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fuljy <br />TF1�9Mbtl, <br />above by proper shipping name and are classified, packed, marked, and labeled, and are in all res is m pro c <br />transport y highway according to applicable international and national governmental regulations. <br />Date <br />Printed/Typed Name C. Collins, Agent <br />Signature , <br />MOonth 29ay 87 r <br />Dick Deschenes <br />T <br />R <br />17. <br />Transporter 1 Acknowledgement of Receipt of Materials <br />Date <br />A <br />Rs <br />Printedrryped Name <br />Sign <br />Month Da Year <br />P <br />C. Collins <br />07 29y 187 <br />n <br />18. <br />Transporter 2 Acknowledgement of Receipt of Materials <br />Date <br />T <br />Printed/Typed Name <br />Signature <br />Month Day Year <br />R <br />19. <br />Discrepancy Indication Space <br />f63 SrAmCa, 5 SLRMcp <br />Ft� <br />�laQ �N y <br />All Cc oN�y.� , <br />o <br />r <br />L <br />20. <br />Facility Owner or Operator: Certification of receipt of hazardous materials covered Ky this manifest except as noted in Item 19. <br />T <br />y <br />Date <br />Printedrryped Name <br />Signature y <br />Month Day Year <br />i c <br />Q ccs <br />3n X <br />Style F15-6 Labelmaster, Chicago, IL 60646 EPA Form 6711(1-22 (3-84) <br />0� <br />