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Form Approved. OMB No. 2050-0039 <br />aac <br />Mu u vi cy N. - <br />UNIFORM HAZARDOUS <br />1. Generator ID Number <br />2. Page 1 of 3. Emergency Response Phone <br />408-363-3678 <br />14. Manifest Tracking Number <br />014649293 FLE <br />WASTE MANIFEST <br />CAR000285262 <br />1 <br />5, Grnaea[ur's Name and Mailing Address G�neminr's SIIP Adrfma; (if different than malling address) <br />ffTAL FINISHING SOLUTIONS - STOCRIUN <br />1325 EL PINAL DRIVE <br />STOCRIUN, CA 95205 <br />Generator's Phone: q25 R712-1 <br />6. Transporter 1 Company Name U.S. EPA ID Number <br />Iwo <br />7. Transporter 2 Company Name U.S. EPA A) Numbor <br />8 Designaled Facility Norne and Site Address U.S. EPA ID Number <br />US ECOLOGY NEVADA <br />Hy- 95 it IM S SOUTH OF BEATTY, P-0- BOY 578 <br />BEATTY, NV 89003 <br />Facility's Phone: <br />ga <br />9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, <br />10. Containers <br />11. Total <br />12. Unit <br />13. Waste Codes <br />No. 1 <br />Type <br />HM <br />and Packing Group (if any)) <br />Quantity <br />Wt.Nol. <br />1• IDN RCRA HAZARDOUS WASTE, SOLID (AL�Ul� <br />181 <br />0 <br />� <br />DA <br />P <br />�a <br />Ill <br />2 <br />W <br />c9 <br />3. <br />4 <br />14. Special Hand€Ing frrstrucUans and Add ltlpnal Informatlon <br />1) 070128300- 29038 RUSE TATER FILTERS <br />BILL 1U ALL CLEM PON 18381 <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 intemationaland 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 />Geao-rator s'Offeror's Prinled7yped Name Signature Month My Year <br />rr^ L 2-1 <br />❑16. Intem al Shr men Import to U.S. ❑Export from U.S. Port of entry/exit: <br />Transporter signature (for exports only): Date teeaing U.S.: <br />W <br />17. Transporter Acknowledgment of Receipt of Materials <br />Transporter 1 P edlTyped Hama Signalure� Month ©ay ear <br />OA'a <br />r�Ll <br />Z <br />7r sparter 2 PAnt&fTyp4d Name Its . Da ear <br />/h sJ vy /Z Lul <br />18. Discrepancy <br />18a. Discrepancy Indication Space ❑ Quantity ❑ Type ❑ Residue ❑ Partial Rejection ❑ Full Rejection <br />Manifest Reference Numbor, <br />18b. Allerna(e Facility (or Generator) U.S EPA ID Number <br />J <br />U <br />GFeellity's <br />Phone <br />w <br />I&c. Signature of Altomale Facillty for Generator) Month Day Year <br />Q <br />Z <br />S219. <br />Hazardous Waste Report Mnnagamont Method Cartes (i.e.. codes for hazardous waste treatmenl, dlspasal, and reryrling sfslema) <br />LU <br />z 3_ 4 <br />'Ws� <br />20. De gnatad Facrlitt Owner or Operator Certification of re of hazardous matsrinN covomd by the manlfesl except as noted in Ilam 181 <br />Parrtwlilrwiedl Name Slgnalu nth �]D`aayy Year <br />4� <br />EPA Form 5700-22 (Rev 1P `I7)''revlous edulons ars onsolele.' ut,-)wlvH I r rAWLI 1 1 1 V Cr'N 5 U- lHrrrr. I I-I.I <br />