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lease print or type,ftrof designed for use on elite(12-pitch)typewriter.) Form Alove&OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 3.Emergency Response Phone 14.manifest Tracking Number WASTE MANIFEST C A L 0 0 0 3 4 1 1 7 424-MO J�� 016706744 JJK- 5.Generators Name and Mailing Address Generators Site Address mailing 0 WESTERN TRUCK CENTER WESTERN TRUCK CENTER PO BOX 32020 3333 S.HIGHWAY 99 STOCKTON CA 96213 STOCKTON CA 95216 Generators Phone: 299 3-2 3 - Z 3 0 0 6;Transporter I Company Name U,S.EPA ID Number FREMOUW ENVIRONMENTAL SERVICES INC C A R 0 0 0 1 7 1 0 1 7 7.Trarispoder 2 Company Nome U.S.EPAID Number WORLDWIDE RECOVERY SYSTEM INC Q 6 R 9 0 0 1 7 5 4 20 2 8.Designated FacIlifty Name and Site Address U.S.EPA ID Number US ECOLOGY INC HWY 95 111 M1 S OF CY 16 ACRES BEATTY NV 89003 racilil�s Phone: 7M M-2203 N V T 3 3 0 0 1 0 0 0 0 ga, 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 111.Total 12.Unit 13.Waste Codes HM and Packing Group(if any)) No. Type Quantity wtivol. 1-NON-RCRA HAZARDOUS WASTE,LIQUIDS(OILY WATER) 223 21 3, 4; 14.Special flandliag Instructions and Addlilonal Information 1)UG t1070131570-9061 OIC Water E+1e*4ala ;?4 IU6B' HANDLE PPK.ER \0 M TO BE 40HR TRAR4W Conhud 0 2DS007 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 labeled/placarded,and are In all respects In proper condition for transport according to applicable International and national governmental regulations.If export shipment and 1 am the Primary Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. I cedlfy that the waste minlmizatlon 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. or'slofferars P60 drrypredftm Day Year 16.International Shipments Import to U.S. ❑Export from U.S. Pod of entry/axII: Transporter signature(for exports only): Date leaving U.S.: Uj 17.Transporter Acknowledgment of Receipt of Materials TM �—da—ipri—j—d—fxyf' d Sig, lonth Day Year Transporter 2 PrintedfTyped Nara, Signature Month Day Year Wr 1 04 11 18.Discrepancy 18a.Discrepancy Indication Space El Quantity 0 Typo Residue Partial Rejection ❑El Full Rejection Manifust Reference Number. 18b,Alternate Facility(or Generator) U.S.EPA ID Number Facility's Phone: 51 1 8c,Signature of Alternate Facility(or Generator) Mand) Day Year U — rl Prin [TMm!nspuddir2 Mdnfleedd S2 19,HazardatlsWaste ftor[Managio,mentMetIM4 Codes(I,o.,codes for hazardous waste,�aabnenl,disposol,and recycling systems) U) LU 9. 2. 3. T 20.Rasigruatad'FaciUty Owner orOperetor.Cadlficatton ecefpl of hazardous malarlals covered tsy 1ha manifest p Printedfryp 'ITI EPA Form 870110—P(ReV.1346)PMViOUS edilons are obsolete. DES16NATED FACILITY TO DESTINATION STATE(IF REQUIRED)