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Please print or type. 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 CM000285262 1 408-363-3678 101464929 FLE <br /> 5,Gentga[ur's Name and Mailing Address Gr.nemInr's Site Addrea5(if different than malling address) <br /> WTAL FINISHING SOLUTIONS - STOCKTON <br /> 1325 EL PINAL DRIVE <br /> STOCRIDN, CA 95205 <br /> Generator's Phone: <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Facility Noma and Site Address U.S.EPA ID Number <br /> US ECOLOGY NEVADA <br /> HET- 95 it MII.ES SOUTH OF DEATTl, P.0. BOX 578 <br /> BEATTY, N9 89003 <br /> Facility's Phone: — <br /> ga 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes <br /> HM and Packing Group(if any)) No. Type Quantity Wt.Nol. <br /> 0 1• SM RCQA HUMMOUS WASTE, SOLID (AT.UKUMM P 181 <br /> �a <br /> z 2 <br /> W <br /> f.7 <br /> 3. <br /> 4 <br /> 14.Special Handiing lnstrudivns and Addltfonal Wormatlon <br /> 1) 070128300- 29038 RINSE TATER FILTERS <br /> HILL TO ALL CLEAN PO# 18361 <br /> 15. GENERATOR'S/OFFEROR'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 t am a large quantity generator)or(b)(if I am a small quantity generator)is true. <br /> Genemlcr's'Offeror's Prinied7yped Name Signature Monlh Day Year <br /> '-� rr-".p 12 2.1 <br /> J 16.IntemNloehal Shipments <br /> El import to U.S. ❑Export from U.S. Port of entrylexit: <br /> Transporter signature(for exports only): Date leaving U.S.. <br /> W 17.Transporter Acknowledgment of Receipt of Materials <br /> 1i Transporter 1 Zia <br /> Signature r � Month D�ayJ ear <br /> O r.t <br /> IL <br /> ZT s iter 2 P of yp Name lh. Da ear <br /> � � icy �z 1 <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference NumC•oc <br /> 18h.Allernalo Facility(or.Generator) U.S EPA ID Number <br /> J_ <br /> V <br /> LL Fecllily's Phone <br /> S Tar.5tgrmhrre of mornate Faeiltty(or Generator) Month Day Year <br /> Q <br /> Z <br /> Cn 19.Hazardous Waste Report Management Method Codes(l.e.,codes for hazardous waste Imatmanl,dlspasat,and reryGing systems] <br /> 0 1. � 2. 3. 4. <br /> 20,De 9naled Facility Owner or operate.Certification of reW of haaardws materials covered by the manlfest except as nded in Item 18a <br /> Pdayipwd Name ty Signor P nth -Day VON <br /> Aw <br /> EPA Form 8700-22(Rev.1 T) revious editions obsolete. DESIGNATED FACILITY TO EPA's e-MANIFF:ST 5YSTE <br />