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Please print or type V `- S(")L/ Form Approved.OMB No.2050-0039 <br /> I.Genetalor ID Number <br /> T2P4e 1 of 3.Em ��ccy n I1 4.Manifest Tracking Number <br /> UNIFORM HAZARDOUS (%U U.!� s {� 02059,2147 JJ K <br /> WASTE MANIFEST CAL 000 000 293 <br /> 5,Generator's Name and Mailing Address Generators Site Address(if different than mailing address) <br /> 26700 SOUTH BANTA ROAD <br /> TRACY, CA 95304 <br /> Generator's Phone: 702 06-2610 O <br /> 6 Trarrsportnr 1 Company Name U.S.EPA ID Number <br /> EQ INDUSTRIAL SERVICES MIK 435 642 742 <br /> 7,Transporter 2 Company Name U.S.EPA ID Number <br /> BED Rock INC. DBA TSMTCO Moa 095 038 998 <br /> 8.Oesignated Facility Name and Site Address US ECOLOGY IDAHO, INC. U.S.EPA ID Number <br /> 20400 LEMLEY ROAD IDD 073 114 654 <br /> GRAND VIEW,ID 83624 <br /> Facility's Phone: (800) 274-1516 <br /> ga 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Gass,ID Number, 10.Containers 11.Total 12.Unit <br /> 13.Waste Codes <br /> HM I and Packing Group(if any)) No. Type Quantity Wt.Nol. <br /> 1. <br /> NONHAZARDOUS NON REGULATED 003 DM 00635 P <br /> 0 <br /> z 2 <br /> w <br /> C9 <br /> 3. <br /> 4. f <br /> I <br /> Sad Additional Information <br /> WTH OIL fT:14.14.75rFfi.1I <br /> 15. GENERATOR'StOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, <br /> marked and labeled/placarded,and are in all respects In proper condition for transport according to applicable intemational and national governmental regulations.If export shipment and I am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terns of the attached EPAAcknowledgment of Consent. <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a small quantity generator)is true. <br /> Generator'sl0(ferces Perntedayped Name Signal Month Day Year <br /> � � P�v 0 121 20 <br /> 16.Inlemational ShlpmenEs ❑Import to U.S. ❑Export from U.S. Port of entry/exit: <br /> ? Transporter stgnakue(far exports only): <br /> Date leaving U.S.: <br /> W 17.Transporter Acknowledgment of Receipt of Materials <br /> Transporter 1 Printedfryped Name g <br /> atire Month Da Year <br /> 11. 0 121 20 <br /> i <br /> ser2PdntedlTyp Name Signature Morlh Day Year <br /> Tia <br /> 1e.Discrepancy <br /> 18a.Discrepancy Indication Space Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number. <br /> 18b.Alternate Facility(or Generator) U.5 EPA ID Number <br /> J <br /> U <br /> LL Facilliyrs Phone: Month Day Year <br /> w 16c.Signature ofA female Faciilty(or Generator) <br /> Q <br /> z <br /> Fn—CD <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 0 1. 4. <br /> W H132 z 3. <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except a,noted in Item 18a <br /> PrinledlTyped Mame 5ignalure Month Day Year <br /> O <br /> EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM <br />