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sI <br /> e print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 <br /> 1.Geneator tD Number �2ftge of 3.Emergency Response Phone 4.Manifest Tracking NumberUNirORM HAZARDOUS 800.424-9300 000811521 FLEWASTE MANIFEST CAL000225782 <br /> 5.Generator's Name and Mai;ng Address Generators Sita Address(i different than mailing address) ?I <br /> SP West Coast Products, LLC 05469 i <br /> P.O. Box 80249 130 S WILSON WAY <br /> Rancho Santa Margarita, CA 92688 949460-5200 STOCKTON, CA 95205 <br /> Generators Phone: U.S.EPA ID Number <br /> 6.Trari 1 Company Name <br /> BELSHIRE CAROflp183913 <br /> U.S.EPA ID Number <br /> 7.Transporter 2 Company Name <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number <br /> US Ecology,Nevada Operations <br /> Highway 95, 12 miles S. of Beatty NVT330010000 i <br /> Be <br /> Facfi s roWl 89flQ3 775-553-2203 I <br /> 96.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes <br /> No. <br /> HM and Packing Group('4 any)} Type Quentlty WtNol. <br /> # <br /> 1 Non-RCRA Hazardous Waste, Solid P 611 <br /> !I <br /> Z 2- <br /> li <br /> 0 <br /> 3. <br /> i <br /> k <br /> 4. <br /> FDLD LABEL AT <br /> 14.Special Handing Instructions and Add tional Ir fomla6on YEAR ALL APPROPRIATE BESI:147E48 LINE.AFFIX Ti <br /> PERSONAL PROTECTIVE SIDE OFeBULs <br /> EG:U!PMENT. TAB SMS W ,I <br /> MOM Imear w <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping narrre,and are dassified,packaged, <br /> marked and labeledlplacarded,and are in all respects in proper condition for transport according to applicable international and a vemmental regulations.If export shipment and I am the Primary <br /> Exporter,I certify that the contents of this oormsgnmem conform to the terms of the attached EPAAdmowiedgment of Cons <br /> I certify that the waste minimization statement identified m 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I a smail qu cry generator)s true. <br /> Nio <br /> Genaratoesl o s noted, ypetl Name <br /> ignature n ay ear <br /> Larry Moothart of BESI on behalf of generator <br /> J 16.International Shipments Pon of entrylexB: <br /> ❑import to U.S. ❑Export tram U.S. <br /> Transporter signature for exports only): Date lei I U.S.: <br /> i <br /> W 17.TransponerAcknowledgrnenl of Receipt of Mate els ont ay ear t <br /> Transporter 1 Printed/Typed Name Signatur-SIe <br /> i(( <br /> agnature <br /> � I <br /> Transporter 2 PdntedlTyped Name <br /> oa h ay Year <br /> F- <br /> 18.Discrepancy ! <br /> 18a.Discrepancy,Indication Space T Rejection El Full Rejection <br /> ❑ Quantity ❑ YPe __ Residue Partial <br /> Manifest Reference Number. <br /> U.S.EPA ID Number <br /> r 18b Alternate Facility(or Generator) <br /> J <br /> V <br /> LL Facili s SignaPhone: Month Day Year <br /> W 180. hue of Altemate Facility(or Generator) <br /> a <br /> z <br /> 19.Hazardous Waste Report Management Method Codes(.e.,codes for hazardous waste Voatment disposal,and recycling systems) <br /> o t' 2 3 4 <br /> 20.Des gnated Facility Owner or Operator Certffication of receipt of hazardous materials covered by the manifest except as noted in Item 18a Year <br /> Prin�dlT Name Signature Month Day <br /> EPA Form 8700-22(Rev.3.05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />