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'Pleaselint or <br /> P type. Form Approved,OMB No.2060-0039 <br /> UNIFORM HAZARDOUS 1 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phoner6205925-50 <br /> ifest7racidng Number <br /> WASTE MANIFEST CAL 000 379 503 2 - - 30397 JJ K <br /> 5.Generators Name and Mailing Address RT 8r FINAL#393 Generators Site Address(if different than mailing address) <br /> P O %1, <br /> 502377M� 744 WEST HAMMER LANE <br /> LOS AELES,CA 90051 STOCKTON CA 95210 <br /> Generators Phone: (209)952-1030 <br /> 6.Transporter 1 Company Name U.S.EPAID Number <br /> Eck INDUSTRIAL SERVICES MIK 435 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> BLED ROCK INC, 0E3A TSMTC0 MoD 095 038 999 <br /> 8.Designated Facility Name and Site Address US ECOLOGY IDAHO,INC. U.S.EPA ID Number <br /> 20400 LEMLEY ROAD IDD 073114 654 <br /> GRAND VIEW,ID 83624 <br /> Facirityrs Phone: $QQ 274-1516 <br /> 98 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit <br /> HM and Paddng Group(d any)) No. Type Quantity WLA(d. 13.Waste Codes <br /> o X 1 UN11464,WsmAerosols,2.1 (DOT-P 11288), ERG*126 001 DM 00021 P 12001 12002 331 <br /> UJ <br /> X z UN3286,Waste Corrosive liquid,basic,inorganic, n.o.S. 001 DF 00017 P D002 122 <br /> i(Sodium Hydroxide,PotaSSIUM Hydroxide), 8,PGII, ERG#154 <br /> X 'UN1791,V*ste Hylochlorke solutions, 8,PGII,ERG*154 001 DF 00013 P D002 122 <br /> X 4 UNI 9",WaSte Matches,Safety,4.1,PG III,ERG*133 041 DF 00009 P D001 141 <br /> 14.Special Handling Instructions and Additional Information <br /> 1. SI:RMI T SFHM1- AEROSOLS 2.SFHW04 f SFHWW-CORROSIVE BASE LIQUIDS&SOLIDS 3.SFHWnb t SFHWM-BLEACH & <br /> BLEACH SPILL CLEANtlPlABSORBANTS 4. SFHW07 f SFHWO7-MATCHES.WETTED IT:14.19.73101.13) <br /> 15. GENERATOWSfOFFEROWS CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packq ed, <br /> marked and labeled/placarded,and are in all respects in proper condition for transport according to applicable irdemationaland 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 EPAAdowMedgment of Consent. <br /> foertify that the waste minimization statement identified In 40 CFR 262.27(a)(d I am a large quantity generator)or(b)(rfl am a small quantity generator)is true. <br /> Generaloesl0fieroes Pnntedrryped Name Signature OR5WOf SMART&FINAL STORES LL( Month Day Year <br /> �.� 111 21119 <br /> 116.International Shipments <br /> t- ❑Import to U.S. ❑Export fro .S. Port of entrylexit <br /> ? Transporter signature(for exports only): Date leaving U.S.: <br /> W 17.Transporter Ackn�ment of Receipt of Materials <br /> LU <br /> ji Transporter 1 PdntedlTyped Namey Signa Month Day Year <br /> i �-4-cep 1��?7> 11 21 19 <br /> aZ Transporter 2 Printedfryped Name Sig re Month Day Year <br /> K <br /> F <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J_ <br /> V <br /> ti Facility's Phone: <br /> uj I Sr-Signature of Alternate Facility(or Generator) Month Day Year <br /> a <br /> X <br /> N19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> al. H141 2 H132 3 H132 4 H132 <br /> 20.Designated Facility Owner or Operator.Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Pdntedflyped Name Signature Month Day Year <br /> EPA Forth 8700-22(Rev.12-17) Previous edrdons are obsolete. DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM <br />