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RECEIVED BY SJCEHD (EF) on 12/4/2019 <br /> a a <br /> Pieria print or type. Form Approved.OMB No.2050.0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2-Pagelof lEmerr�e Response Ph" ManifastTracfdngNumber <br /> WASTE MANIFEST CAL 000 379 503 { (8U ' $39-391' T020590300 <br /> J J K <br /> 5.GeneratcrsNameandMairngAddmssRT&FINAL#393 Generators Site Address(ddifferentthanmalingaddress) <br /> ATTN.NICOLE ADAME 744 WEST HAMMER LANE <br /> P.A. BOX 512377 <br /> LOS ANGELES, CA 90051 STOCKTON, CA 95210 <br /> Generator's Phone: 9 9 <br /> 6.Transpoder 1 Company Name U.S.EPA I D Number <br /> EQ INDUSTRIAL SERVICES MIK 435 842 742 <br /> 7.Transporter 2 Company Name U.S,EPA i D Number <br /> BED ROCK INC.DIRA TSMTC0 MOD 095 038 998 <br /> 8 Designated Fadhty Name and SiteAddness U.S.EPA ID Number <br /> US ECOLOGY IDAHO,INC. <br /> 20400 LEMLEY ROAD IDD 0731 U 654 <br /> GRAND VIEW,ID 83624 <br /> Facilli IsPhone: 800 <br /> 9a 9b.U.S.DOT Desaiptim¢nduding Proper Shippfng Name,Hazard Gass,ID Number, 10.Containers 11.Tota! 12,Unit II Waste Codes <br /> HM and Packing Group(if any)) No. Tl Quantity WtNal. <br /> a X 1• UN 1950,Waste Aerosols, 2.1 (DOT-SP 11296).ERG#126 601 DF 00011 P 0001 DOOd 33 <br /> X 2. RQ,11N3266,'W+ ste Corrosive liquid, basic,inorganic,n.o.s. 043 DF 60168 P 0602 1 <br /> (Sodium Hydroxide,Potassium Hydroxide),8,PG 11,(RO: <br /> 0002),ERG#154 <br /> Non-RCL AHazartdous Waste,Liquid(Consumer Products) 002 OF 00046 P 331 <br /> 4. <br /> 14 S Hand lfn InstNCtionsand Additional Iniormation <br /> 1. a�" 1�SFHv°I- AER030LS 2.SFHM I SFHM-C0RROWE BASE LIQUIDS&SOLIDS 3.SFN HMI I SFNHM1 - <br /> NON-14QMDOUS UQLIIDS&SOLIDS iT:14.19.70 M.191 <br /> 0-416 SIS <br /> 15. GENERATOR'SICFFERDR'S CERTfF1CATION.*I herebydadare that the contents of this oonstgmwd are fully and acauatey de=ibed above by1he proper shipping name,and are class fled,pacimed, <br /> masked and tabeledfplacarded,and are In all respects in proper twnd w Ter Vaasportaocading m apprable intemational and national governmental regulations.If export shipment and I am the Primary <br /> Exporter,I wT4fythat Ore contents of this mnsigruncnl oWorm to the terms of the attached EPAftiew"ment of Consent. <br /> I oertit)r that rhe waste nimQnQatkm statement identified In 40 CFR 26227(a)(d i am a targe quantity generator)or(b)(dl am a small Quantity generator)b We, <br /> taVOffemrsPnntedlrypedNama at {ORES LL( Mmfh Day Year <br /> la , a C_ <br /> ` 081 291 19 <br /> J 16.Intematiarel SNpmenfs <br /> ❑importfoU.S. ❑ExparttromU.S. Q6 entryrexit <br /> Transporter slgnalure(lar exports only). Date leaving U.S.: <br /> W 17.Transporter kknowledgment of Reeeiptof Materials <br /> ka <br /> r1 Printe0ypedNama ignaNre Month tray Year <br /> 'tN A C.-klw 1 t ' 081 291 19 <br /> Z Transporter 2 Printodlryped Na Slgnatura M Day Year <br /> 18.Discrepancy <br /> tea Discrepancy hific tion space E] Quantity ❑Type ❑Residue ❑partial Rejection ❑Full Rem <br /> Manifest Reference Number. <br /> 18b.Altamata Facility(orGenerator) U.S.EPA ID Number <br /> 0 <br /> Facility's Phona: <br /> w 1 ec.Riature of Wtemate Factlity(or Generator) Month Day Year <br /> 19.Hazardous Waste Report Management Method Codes O.e.,codes for hazardous waste treatment,disposal,and recyang systems} <br /> H141 H132 H132 <br /> 20.Des gra FaCTty owneror operator:Certification ece t W hqNcts materials orjged by the mardrest a rated in <br /> PrintealT sigma a <br /> EPA Form ev.12-M 41rejous ed 'on olete. DESIGNATED FACILITY TO 'S e- [FEST SYSTEM <br />