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Please unto 0 J CD&D <br /> p type.(Form designed for use on elite(12 pitch}typewriter.) 4 Form Approved.OMB No.2050-0039 <br /> a IFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.E � 4.Manifest Tracking Number <br /> WASTE MANIFEST CAR NO 246 470 <br /> 1 01602 859 JJK <br /> ed s if different than mai€in address) <br /> TEALOO <br /> r CA 952D5 STOCKTON, <br /> Generator's Phone: (20)4kU-7041 <br /> 6.Transporter 1 Company Name U.S,EPA ID Number <br /> - <br /> I W <br /> K 4-35 642 ,742 <br /> spar 2 C�Ompa y N e U.S_ u er�..� <br /> A � <br /> 8.Designated Facility Name and Site Address ECOLOGY IDAHO,INC. U.S.EPA ID Number <br /> IM X1.4 654 <br /> GRAND ,M 83624 <br /> Facility's Phone: --1516 <br /> ga, 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10,Containers 11,Total 12,Unit <br /> HM and Packing Group(if any)) No. Type quantity Wt.Nol. 13,Waste Codes <br /> 1. ' <br /> v - - gal, _1„ � w <br /> is ) <br /> 3. <br /> i <br /> 4. <br /> 1 <br /> p <br /> 4.aSI ��t1 Rart�t= n9� 9 <br /> 15. GEN ERATOWSIOFFEROR'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 regulatlons.If export shipment and E 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€am a small quantity generator)is Vue. <br /> Generator's/Cf{emr's Printed/Typed Name Signature Month Da Year <br /> Z,1-41Xl,�- <br /> A— - � / _adl , �< 15 1 <br /> 16.Iritemationai Shipments <br /> ❑Impart to U.S. ❑Export from U.S. Port of entryexit: <br /> Transporter signature(far exports only): Date leaving U.S.: <br /> LZ 17.Transporter Acknowledgment ofRace#ofMaterials <br /> Transporter 1 P intedffyped Name Signature Month Da Year <br /> f" t - 1 <br /> 00 <br /> � r-,� <br /> a po or rin y Nam— Sig ure <br /> Man>t ay Year <br /> IT <br /> A 18.Discrepancy <br /> 18a.Discrepancy Indication Space EI <br /> Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> 3 Sb.Alternate Facility(or Generator) U.S.EPA ID Number <br /> Facility's Phone: <br /> &u 1Be.Signature ofAltemate Facility(or Generator) Month Day Year <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> ['1 12. 3, 4, <br /> 20,Designated Facility Owner or Operator:Certification of receip f hazardous materials covered by the manifest exc as ed in Its <br /> P61rilla erne Signal Month Day ear <br /> EPA8700-2 (Rev,3 5) Previous e i s a solete. <br /> %1.aTy I'Fi DaS,�J�):=a <br />