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Please print or type ' U Form Approved.OMB No.2050.0039 Generator ID Number 2.P e 3.Emergency Response Phone 4.Manifest Trackln8 Number UNIFORM HAZARD ®1, ,- n ^ � ' C'' FLE WASTE MAN, -ST` GAL 000 288 540 510-541-2128 v _ u 5,Gene�ales s Name and Mailing Address Generator's Site Address(8 different than mailing address) (iu OOen ote dumber 3033 S A►rport Way Sicdaon,CAP909 Generator's Phone. 200-2U--7700 6.Transporter t Company Name U.S.EPA 10 Number Big Sky Environmental Solutions CAL000346010 7 Transporter 2 Company Name U.S.EPA 10 Number EQ Industrial Service _ hl1EiC 435 642 742 8 Q s gaated�aciGty Name and Site Address U.S.EPA ID Number t.o 00y 11!Grr sy 95 12 mita:;ioulh o! Faut,ti s Phone 775-653-2203 Nkr 330010000 oa 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class.10 Number. 10.Containers 11.Total 12.Un.t 13.Waste Codes htj and Packing Group)if any)) No. Type Quantity WWI Q: I r` r–. 332 a Nan-RCRA hazardous Vjaste, Solid (Debris) ��l � L� ��— � Z 2 LU i i 3 ! f �l �Instructions and AgAre lipy fjfln Proms 0 070128300-25181 EMERGENCY CONTACT .TEFF RHODES 15, GENERATOR'SIOFFEROR'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 marked and labeledlplacarded,and are in all respects in proper condition for transport according to applicable international and national goverrenental regulations.11 export shipment and I am,he Primary Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quartity generator)or(b)(if I am a small quantity generator)is true. GeneratoeslOfleror's Printed/Typed Nacre Signature_? Mont/ Day) Year 16.International Shipments p_ ❑Import to U.S. El Export from U.S. Port of entry/exit: ? Transporter signature(fo•exports only): Date leaving U.S.: 0C 17.Transporter Acknowledgment of Receipt of Materials tt-- Transporter 1 Printed/Typed Name Signature A Month Day Yea- a ZTransporter 2 PnntedlTyped Name Signature— �;` �: Month Day Year 18-Discrepancy 18a Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue " ❑Partiaf Rejection ❑Full Rejection Manifest Reference Number, 18b.Alternate Facility(or Generator) U.S EPA ID Number U I Facility's Phone: W 18C.Signature of Altemate Facility(or Generator) Month Day Year Q Z N 19 Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) G 1 2. 3. 4. 20.DesWn Fadlity 6wno_7y10 Operator.Certification of receipt of hazy nus alefialstoovered by the manifest except as notlid in 1 m 18a Printed/Typed Name Signature / Month Day Yea 'VL EPA Form 8700-22(Rev 12-17) Previous editio s are obso)ete. DESIGNATED FACILITY TO GENERATOR