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Please print or type. (Form designed for use on elite ( ch) typewriter.) b Form Approved. OMB No. 0-0404. Expires 7.31-86 <br />Al <br />UNIFORM HAZARDOUS <br />21. Generators US EPA ID No. Manifest Document No. <br />2 Page 1 <br />Information in the shaded areas <br />WASTE MANIFEST <br />CAD 063547996 0002 <br />of <br />is not required by Federal law. <br />3. Generators Name and Mail1ing Address <br />A. State Manifest Document Number <br />Stampco Inc.MUk Transportation Inc. <br />3032 El Dorado 6 <br />aio�s Phone 5$g 952066-0481 <br />B. State Generator's ID <br />4. Gene <br />CAD 063547996 <br />S. Transporter 1 Company Name B. US EPA ID Number <br />C. State Transporter's ID <br />Stampco Inc. I CAD 063547996 <br />D. Transporters Phone - - <br />7. Transporter 2 Company Name 9. US EPA ID Number <br />E. State Transporter's ID <br />F. Transporter's Phone <br />9. Designated Facility Name and Site Address 10. US EPA ID Number <br />G. State Facility's ID <br />Enviro Safe Services of Idaho <br />10.5 Miles N/W of Grandview <br />H. Facility's Phone <br />Grandview Idaho 83624 1 IDD 073114654 <br />208-834-2275 <br />11. US DOT Description (Including Proper Shipping Name, Hazard Class and ID Number) <br />12. Containers <br />13. <br />Total <br />14. <br />Unit <br />I. <br />Waste No. <br />0 <br />No. <br />Type <br />Ouantitv <br />WtIvol <br />R <br />a' <br />California Regulated Waste Only <br />R <br />ORM E NA 9189 - DOT Unregulated Waste <br />2 <br />DT <br />0020 <br />CY. <br />611 <br />A <br />T <br />It. <br />0 <br />R <br />C. <br />d. <br />J. Additional Descriptions for Materials Listed Above <br />K. Handling Codes for Wastes Listed Above <br />Contaminated Soil With Diesel Waste Stream <br />Load Must Be Tarped <br />#0322SX <br />15. Special Handling Instructions and Additional Information <br />Ea 1.1 lie <br />AUG 101987 <br />ENVIROMENTAL HEALTH <br />16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully anf&M <br />above by proper shipping name and are classified, packed, marked, and labeled, and are in all respects In proper co�nd! oln�7o7S <br />transport by highway according to applicable international and national governmental regulations. <br />Date <br />Printed/Typed Name C. Collins Agent <br />Signature <br />Month Da Year <br />Dick Deschenes <br />07 87 <br />T <br />17. Transporter 1 Acknowledgement of Receipt of Materials <br />Date <br />A <br />Printed/Typed Name <br />Signature <br />Month Day Year <br />WS <br />Bob Elliott <br />071 29 1 87 <br />P <br />0 <br />19. Transporter 2 Acknowledgement of Receipt of Materials <br />Date <br />R <br />T <br />Printed/Typed Name <br />Signature <br />Month Day Year <br />EM <br />19. Discrepancy Indication Space <br />F <br />A39tAMCO aS' st9wco <br />ld a � � �/`l % <br />14 //CL H �. /1F�te4,16ed t• lKh-C 0A1,L1 r <br />Y3C/67 a2 JDPM . <br />c <br />id <br />}� <br />—r <br />1 <br />L <br />20. Facility Owner or Operator: Certification of receipt of hazardous materials coveWd by this manifest except as not in Item 19. <br />T <br />Date <br />Y <br />Printedlfyped Name <br />Signature <br />Month Day Year <br />c <br />og <br />Style F15-6 Labelmaster, Chicago, IL 60846 <br />ORIGINAL —RETURN TO GENER.4TGR <br />EPA Form 8700-224") <br />