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Please print or type. Form des[ nad for use on elite(12-pitch)f pewrlter,) Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST C A L O O Q 3 4 1 1 7 9 1 s� �2�- 016 7 JJK 0 6 5 0 6 5.Generator's Name and Mallinr3 Address Generator's Site Address(if different than malting addM83) WESTERN TRUCKCENTER WESTERN TRUCK CENTER PO BOX 32020 3333 S.HIGHWAY 99 STOC:KTON CA 9511: STOC:KTON CA 95215 Generator's Phone: 2 d 9 323 - 7300 0.Transporter 1 Company Name U.S.EPA ID Number FREMOUW ENVIRONIVI NTAL SERVICE.; INC C A R 0 0 0 1 7 1 0 -11 7 7.Transporter Company Name U,S.EPA ID Number WORLDWIDE. RECOVERY SYSTEM INC C A R 0 0 0 1 7 5 4 2 2 8.0061 nated racIt t Name and Site Address U.S.EPA ID Number U IWCOL8GY INC HWY 9511 MI S OF CY 16 ACRES BEATTY NV 89003 FadlWsPhone: 775 553-2203:>; N !/ T 3 3 0 0 1 0 0 0 0 ga, 9b.U,S.DOT Description(including Groper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12,Unit 13,Waste Codes HM and Packing Group(if any)) No. Type Quantity Wt Not. 1•NA3077,HAZARDOUS WASTE SOLID,N.O.S.(OILY DEBRIS& D008 223 D007 o X DIESEL SOOT WITH LEAD),9, III I P Divl ill 2, W 0 - 3. 4, 14,Special HanditngInslruatlortsZdAdditional Inforrrta reit 1)US 070127389-222-Oily Debds&Diesel Soot with Lead ERG#171 1 °57 (0111.0"f e.7 HAMIJIMS TO BE 40HR TRAINED AND USE PPE..ER CCmtmd N 205907 15. GENERATOR'SfOFFEROR'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 I am the Primary Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. 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 sommlor);Is true. Goueral&stOiferar's Prinlodffyped Name Signature Month pay Year —i 16.Iniematlonal Shipmants 1..._ f�I � J Import to U.S. ❑Export from U.S. Port of entrylexit: Transporter signature(for exports only); Date leaving U.S.: UW 17.TransporierAcknowledgment of Receipt of Materials Transporter 1 Printed/Typed Name Signature Month Day Year o "1 0-L 2y 1� n. Transpprtor 2 Printed Nam slope Month Day Year ry 18.Discrepancy (( �—1 18a.Discrepancy Indication Space Quanfity O Typa ®Partial Re El Full ❑Residua Rejection Rejection Manifest Reference Number. 18b.Aftemate Facility(or Generator) U.S.EPA ID Number J_ 6J u Facility`s Phone; 8c.Signature a Allarnato Facility(or Generator) Month Day Year S2 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 3, 4. 20.Dosfgn ad hadil .Owner or Operator:Certification of ec pl of hazardous materials covered by the manifest except as noted in Item 18a PdntecU'typod No M104, JAJ SCgaa' t ay � :der EPA.Form 8700.22(Rev.3.05) Previous editions are obsolete. DES `NAT'ED FAQILITY TO DESTINATION STATE(IF REQUIRED)