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185-0'1 • • f jl . ; qv J LL <br /> Pleas�`print oc, pe.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2056-0039 <br /> UNIFORM HAZARDOUS T.Genemtor 10 Number CAL000337276 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST w 1 8— <br /> 001551343 SKS <br /> 5.Genereto's Name and Mailing Address. Generetays Site Address(if different than mailing address) <br /> PACIFIC ETHANOL <br /> 3028 NAVY DR <br /> STOCKTON CA 95206 <br /> Generators Phone: 209-235-0373 <br /> 6.Ta der 1 Company Name U.S.EPA ID Number <br /> SAFETY-KEEN SYSTEMS, INC. TXR000050930 <br /> y7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address US ECOLOGY NEVADA 050505 U.S.EPA ID Number <br /> 11 MILES S OF BEATTY HWY <br /> BEATTY NV 89003 <br /> 775-553-2203 NVT330010000 <br /> Fadlilys Phone: <br /> ga 9b.U.S.DOT,Desniption(including Proper Shipping Name,Hazard Gass,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes <br /> HM and Pecking Group(it any)) No. Type Quantity WIMI. <br /> ' NON-RCRA HAZARDOUS WASTE, SOLID DM P 141 <br /> of (SULFURIC ACID NEUTRALIZED WITH SODIUM q� yy <br /> qa <br /> CARBONATE)' a -`Go <br /> k=4I 'NON-RCRA HAZARDOUS WASTE, SOLID DM P 352 <br /> (UREA) 2 600 <br /> 3. O <br /> i <br /> 4 <br /> 14.Spacial Handling Instructions and Additional Information SK TRCK#110050752 0003281438 <br /> v <br /> SK AUTHORIZE 0 RETAIN LICENSED SUBSEQUENT CARRIERS AS NECESSARY <br /> 15. GENERATOIPSIOFFEROR'S CERTIFICATION: I hereby declare Nal the contents of this consignment are fully and accurately described above by the limper shipping name,and are classified.packaged, <br /> marked and Mbelecilplaarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulators.It export shipment and I am the Primary <br /> Exporter,I cantly that the contents of this consignmentanfam to the terms of Ne attached EPAAcknoMedgment of Consent. <br /> I aNal the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or( (it I am a small quantity generator)is true. <br /> Genera('s/ erers PiltechrType0iPme Sign rel Monty Day Year <br /> Y ( I 109 <br /> 16.International Shipments <br /> F ❑Importto U.S. ❑Export hob U.S. Pod of enhylexit: <br /> Z <br /> Transporter signature(for exports only: Date leaving U S.: <br /> w 17.Transports Aclum ledgmem of Repaid of Materials <br /> Transporter 1 yped Name Signature Month Day Year <br /> o O <br /> 6 <br /> QTransport&2 Printe ifTyped Name tt SignaN Monty Day Year <br /> ce t <br /> 18.Discrepancy f <br /> 18a.Discrepancy Indication Spam 7 <br /> . �� � ❑ Quantity El Type ❑Residue ❑Partial Rejection El Full Rejection <br /> r, Manifest Reference Number <br /> I&Ahtemata Faclliry,(or Generator) U.S.EPA ID Number <br /> a J <br /> U <br /> LL Facllit)'s Pliant: <br /> W 18c.Signature ofNtemate Fadrdy(or Generator) Month Day Year <br /> Q <br /> z <br /> H19.Hazardous Waste Report Management Metltad Codes(i.e..codes forthaunindouswaste oeatrnent,disposal,and recycling systems) <br /> G 1. 2. , 4. <br /> 1 20Des gra edf er aro aar.Certfia6on ofreaip of hazardous materials owed by the manifest ex pt alnnea ImIBA <br /> PrintudlT a e Signature f / <br /> k i <br /> PPyy 77 2 v sedi b sareobsolete. OE I NATED FACILIT�TO GENERATOR STATE(IF RE UI ) <br /> E110 2 0 ) O�g�l �2 � 4) <br /> 1)2417015/40301387 2)2417017/4030138'10492.0256 <br />