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. <br /> i <br /> I <br /> Please print or type. <br /> Form Approved . OMB No. 2050-0039 <br /> UNIFORM HAZARDOUS 1 • Generator ID Number 2. Page 1 of 3. Emergency Response Phone 4. Manifest Tracking Number <br /> WASTE MANIFEST GAR000285262 D 408 -363 --moi_ ? t 021107903 JJ K <br /> 5, Generator's Name and Mailing Address Generator's Site Address (if different than mailing address) <br /> tWTAL FINISHING SOLUTIONS - STOCIMN i <br /> 1325 EL PINAL . DRIVE <br /> raT0CR"MNf CA 95205 <br /> Generator's Phone: q rp 8) _ 4 J36 r, q <br /> 6. Transporter 1 Company Name U .S. EPA ID Number <br /> ALL CLEAN HAS ARDOUS WAS <br /> 7, Transporter 2 Company Name U .S. EPA ID Num er <br /> I <br /> 8, Designated;Facility Name and Site Address U.S, EPA ID Number <br /> US ECOLOGY NEVADA <br /> Rf7C . 95 11MILES SOUTH OF ISEATPY , P . O : BOX '578 <br /> nEATI'Y , NV 89003 <br /> Facility's Phone: 775 .553 .2203 0q4! 089i4 <br /> 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Containers 11 . Total 12. Unit <br /> 9a. p 13. Waste Codes <br /> HM and Packing Group (if any)) No. Type Quantity Wt.NOI. <br /> 1 . RQ , UN3266 , WASTE CORROSIVE LIQUID , DASIC , <br /> DF d D002 991 <br /> O INORGANIC , A _ O . S _ r Be PG -III ( SODIUM � D F` <br /> DISILLICATE , SODIUM HYDROXIDE) <br /> w 2• NOW RCRA HASARDOUS WASTE , SOLID (ALUMINUM , Y 181 <br /> c7 FILTERS ) DA 'b <br /> 3. <br /> i <br /> 4. <br /> i <br /> 14. Special Handling Instructions and Additional Information �[ <br /> 1 ) 070137710 - 19779 CLEANM CCWOUND SLUDGE � � p I <br /> 2 ) 070128300 - 29038 RINSE WATER FILTERS JbAw <br /> AC PO# 15530 ERG # 159 , 171 <br /> 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, <br /> 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 <br /> Exporter, I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment 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 I am a small quantity generator) is true. <br /> Generators/Offeror's PrintedlTyped Name Signature Month Day Year <br /> Co►7 Y Dr�L � - I � � <br /> 16. International Shipments <br /> � ❑ Import to U.S. Export from from U .S. Port of entry/exit: <br /> Z Transporter signature (for exports only): Date leaving U.S.: <br /> W 17. Transporter Acknowledgment of Receipt of Materials <br /> Tra �orter 1 Print (d/Typed Name Signature Month Days Year <br /> a � t� 12U <br /> Z Transporter 2 Printed/lyped Name Signature Month Day Year <br /> 18. Discrepancy <br /> 18a. Discrepancy Indication Space <br /> ❑ Quantity ❑ Type El Residue El Partial Rejection El Full Rejection <br /> i <br /> Manifest Reference Number: <br /> 18b, Alternate Facility (or Generator) U .S. EPA ID Number <br /> U <br /> Facility's Phone: Month Day Year <br /> w 18c. Signature of Alternate Facility (or Generator) <br /> z <br /> 0 1 - .. ,_ - . _ ., - - - s . . .. . _ _ _ __. . ._ a r..a,.., r. ,.,.a,,n a..r r.n-,...an„e u,oefo 4rontmant Aienncal and rarvrlinn ay.qtA.msl <br />