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I R <br /> ........... P- <br /> 3 <br /> 'S.Gen =i , . <br /> erators Name and Maillhg�kddrdgs� Genera ors,Site Address irt ditterent than mailing adoreisy, -7 <br /> AUTOZONE CALIFORNIA AU,T OZONE # 5686 <br /> PO BOX 2198 ATTN BRYAN BLAIR 1448 N EL DORADO ST <br /> MEMPHIS TN 381.01-2198 <br /> Generator's Phone: 209-93,91-9132 9TOCKTON CA 95202-1019 <br /> 6.Transporter I Com Name ame U.S.EPA ID Number <br /> -ET – -EN -Ems, INC. <br /> SAr Y- sysi TXR000050930 <br /> 7,Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address US ECOLOGY NEVADA f1:1 IN,Number <br /> 11 MILES S OF BUITTY HWY 95 <br /> 800--239-3943 BEATTY NV 8900q, N VT3 3,0 12.11,0 0 0 0 <br /> Facility's Phone: I <br /> ga. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,10 Number, 10,Containers it.Total 12.Unit 13.Waste Codes <br /> HM and Packing Group(if any)) No. Type Quantity Wt./Vol, <br /> NON RCRA HAZARDOUS WASTE,801—ID i DM P 352 <br /> (ABSORBENT) <br /> Z 2. <br /> UJI <br /> � <br /> H ling Anstiuctl <br /> one and Additional Information <br /> SK SFIIPX 53394916 2881068 Cria <br /> 24 HR EMERGENCY #1-800-468-1760 (SAFETY—JKLEEN' — CONTRACT #94138) <br /> SK'.AUTHORIZED TO RETAIN LICENSED SUBSEQUENT CARRIERS AS NECESSARY <br /> 070140600-380 <br /> 15.' GEN ERATORISIOFFEROR'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 EPAAcknowledgment 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 /> Z o <br /> r 0 roes Printedrryped Name Signa re Month Day Year <br /> jn CA4A <br /> Interhatidnal Shipmehis <br /> -r-1 import to U.S. El Export from U.S. Port of entry/exit: <br /> Transporter signature(for exports only): Date leaving U.S.: <br /> UW 17.Transporter Acknowledgment of Receipt of Materials -------- <br /> Transporter I Dyinted/Typed Name Signature Month Day Year <br /> 0 <br /> U) <br /> Z Transpor-W 2 FrintedfTyped N Signature <br /> Month Day Year <br /> F- L I <br /> 18.Discrepancy <br /> 18a.Discrepancy Indicailon Space ❑ <br /> Quantity Type ❑Residue FP,dial Rejection El Full Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U,S.EPA ID Number <br /> LL Facifity's Phone: <br /> C' 78c.Signature of Alternate Facility(or Generator) <br /> LLJ Month Day Year <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 1 2. _13. 4. <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Printed/Typed—Nam. Signature Month Day Year <br /> EPA F 68-LQQ-J2(QQv.3-05) Previous editions are obsolete, DESIGNATED FACILITY To DESTINATION STATE(IF REQUIRED) <br /> C , _ <br />