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Please print or type. Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number7 Page 1 of 3.Fmnrgenry Response Phone. 4.Manifest Tracking Number <br /> WASTE MANIFEST 020623156 JJ K <br /> 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) <br /> JB Hunt <br /> 615 JB Hunt Corporate Drive Lowel, AR 72745 1624 Army Ct <br /> Generates Phone: 800-452-4868 - Stockton CA 95206 <br /> 6.Transporter 1 Company Name U.S.EPA 10 Number <br /> Ancon Marine CAD980737068 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> L. VV-- L_ V v\ L-w tv f up 36 L1 <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number <br /> Crosby & Overton <br /> 1630 W. 17th St. - Long Beach, CA 90813 <br /> Facility's Phone: (562)432-5445 <br /> ga 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit <br /> 13.Waste Codes <br /> HM and Packing Group(if any)) No. Type Quantity Wt.Nol. <br /> o ' Non-RCRA Hazardous Waste Solid (Diesel, Debris) 352 <br /> ,Z. DM (J P <br /> w <br /> UJI <br /> 0 2. <br /> NA1993, Combustible Liquid, n.o.s., (Water, Diesel), 343 <br /> Combustible Liquid, PGIII DM <J G <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional Information j, <br /> 1.ERG 171 Debris( Lx559)Profiki#99611 P�5 6 c: I <br /> 2.ERG 128 Bulk Llquk1(I )55{1)Prot'Ae#112556 ERG Book InVoh *:Wwprow lS 5 <br /> 3. OSHA Wproved PPE Whm h@W k p M <br /> 4. mowwsonWsmr ant. Jib# 400.13.26375 <br /> 15. GENERATOR'S/OFFEROR'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 international 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 terms 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's/0%eror's Printed/Typed Name U(-I i`7�,r.M ,L-r Di= -J i I tit- Signature _ - 7 Month Day Year <br /> 16.International Shipments <br /> ~J p ❑Import to U.S. El Export from U.S. Port of entry/exit: -_-_._ <br /> ? Transporter signature(for exports only): Date leaving U.S.: <br /> W 17.Transporter Acknowledgment of Receipt of Materials <br /> LLJ <br /> Transporter 1 Printed/Typed Name Signature _.....____� Month Day Year <br /> a L U <br /> Trans 2 Printed/Typed Name Signature'/ Me 8i Day Year <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space Quantity ❑Type ❑ResidueElPartial Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J_ <br /> U <br /> � <br /> Facility's Phone: <br /> w 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> I <br /> Q <br /> Z <br /> FA19,Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> UJ 1. 2. 3. 4. <br /> �.� -A�` ::�5 <br /> 20.Designated Facility Owner or Operator:Certification of rec' t of ha ous materials covered by the manifest except as nde to Item 18 <br /> Prin d/Typed ame 1 Signature /'-- M nth Day Ye <br /> (., <br /> EPA Form 8700-2 (Rev.12-17) Pre ions editions are obsolete. DESIGNATED FACILITY TO EPA's e-MA (FEST SYSTEM <br />