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00f98.2144. <br /> Please print or type.(form de ned for,use on elite(12-pitch)typewriter) Forth Approved.OMB No.205Q0039 <br /> UNIFORM HAZARDOUS 1 1."'mfeW lO Nunber 2.Papel of 3 Emer9ency Response Panne 4.Man"TWkIng Numbs <br /> WASTE MANIFEST CAROW144410 1 949-099-3709 000768738 FLE <br /> 5.GenOPHYS Hama and Maaln9 AddreeS Gm rales She A¢drenf deferent Nan mowing address) <br /> USA Petroleum Corporation USA 0835 <br /> 605 Rancho Conejo Blvd. 2705 Cotatry Club Blvd <br /> Newbtay Park,CA 91320 919-480.5200 Stomion' CA 95204 <br /> Cxnenmrs Ph" <br /> .Tuansponer 1 CwWy Nam U.S.EPAID Number <br /> BELSHIRE ENVIRONMENTAL SERVICES, INC. CAR000165175 <br /> 7.Transporter 2 Canpany Name U.S.FPAIDNunber _ <br /> e. sgreedF0irf Name and beeA ess U,S.EPA ID NUmbm <br /> US Ecology, Nevada Operations <br /> HigFmay 95-, 12 miles S. of Beatty - NVT33i1010700 - <br /> FBe s 1 890031: 775-551-2203 <br /> 91L 9b.U.S DOT DesoyAionRKWN PmperShgpirp Nam,Hamm Clan,ID Nunber, 11 <br /> .Cw!ainan 13.Wash Codas <br /> 11.Tmal 12.I;nn <br /> HM' and Petlnq Gmq(aamy)) Na. Type Ovanity 'At`N <br /> Solids,Containing Flammable Liquid,n.o.s.,4.1. UN3175, 352 <br /> x " 001 DM 50L <br /> = 2 <br /> W <br /> c7 <br /> 3. <br /> d. <br /> 14,SDwW Him"mawap!s and Aeefww mfamalion VV:AR ALL APPROPRIATE SESt?136199 ' <br /> ERGO 133 :1'e PROTECTIVE CLOTHING <br /> 001 - o3N � <br /> 16. GENERATOR'SIOFFEROR'S CERTIFICATION:I hereby dwJwe Nal se contends of the mnsignmt are Uly and auarealy desnAed abaft by the pops shipprg nam,and are Waged.packaged. <br /> maMed and Iabs"acamed,and are in all mspKts at pops m dddn for amspml aamom9lo appliwbk enemaidlul and nallorei gofemnsnW iepNaliors.If e!pW WYprse and I am the Prinnsy <br /> Exmw.I ceraly'nal da wnlen6 of me wrlWTmenl mn mm m da tens dna anadad EPA Acknoaledgmsn of Consent <br /> I candy dalnemesm minimization statement Identified h 40 CFR 262.27(a)(d l am a large warygeneraw)m(b)(I l am a small )istim. <br /> Genernoest0farors ase !ure y Y., <br /> Larry Moothaft of BEST an behalf of penerato / 107 <br /> J 16.International Saip wis ad w h' U S. <br /> ❑ <br /> p- ❑Esparl M1am US. demrylmdt <br /> Z <br /> Tramponer WaWne fors Dale ImAng U.S.: <br /> f7.Tm A&r�vMe0wt W Rwmplof MalpiWa <br /> S, r�mpo!bf 1 PMI y Name Y w <br /> y 3a/ 07 <br /> } Year- <br /> 18.Dixxepancy .. - .. <br /> t6a.OkamKy l!'Qcebon Space ❑auantity ❑;r."e ER.:s El Partial RejeW. ❑FU7 Refection. .. <br /> nanl'm RelaanC Nv .der: <br /> lar.A ternam Fwfn,(a Generator) U.S.EPA ID Numbs <br /> J <br /> U <br /> qLLq <br /> 1j C'�srf.N_111Essay(Ae «canmetod r'a.a,?Ytylrt - _- - Mann.roY _ Y_w_... <br /> � r wr:'15 <br /> H19.Hamadss Waste Report Management Menta Lades(i.e.modes for aeuooua waste vaa!menlL di and"'worg syWems) <br /> 2. 1 4. <br /> 20.De& aad FacsayDome wOpeimor.CeNfNelw M receipt of hwardow materials covered by rte Pendent eacepl u now in ttpn 18a <br /> PfetletllfYped _ fifInabxe MOM Day men <br /> EPA FormS70D22(Rev.3-05) ednonsareobsolete. N 6FACILITYTO GENERATOR STATE(IF REQUIRED) <br /> 10166.1778 i� <br />