CO0052275 (2) - Laserfiche WebLink

Home Browse Search

- -Form Approved. OMB No. 2040-0039 Please print or type. GENERATOR ). I UNIFORM HAZARDOUS WASTE MANIFEST 1. Gene rator ID Number CAC00307R887 2. Page 1 of 1 3. Ernergency Response Phone Ron-ssci-gn90 4. Manliest Tracking Number I .020623101 JJK Generator's Name and Mailing Address Generator's Site Address (if different than mailing address) JB Hunt , 815 JB Hunt Corporate Dr Lowell AR 72745 Arch Rd and Logistics Dr Generator's Phone: 4797820-0000 - .. 1 Stockton, CA 95216 .1 Transporter 1 Company Name U.S. EPA ID Number • Ancon .Marine I CAD980737068 1 Transporter 2 Company Name US. EPA ID Number , I I S. Desig nated Facility Name and Site Address U.S. EPA ID Number US Ecology ., Highway 95, 11 miles South of Beatty, NV, Beatty, NV 89003 Facility's Phone: (775) 553-2203 I NVT130010000 I I i i ga 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Confiners 11: Total 12. Unit 13. Waste Codes I _ Hm i and Packing Group (if any)) No. Type Quantity, Wt1Vol. i Non RCRA Hazardous Waste Solid (Diesel Fuel, Debris) 352 . 1 CM 20 Y i 1 _,., x . _ - • I 14. Special Handling Instructions and Additional Information 1. ERG 171 Debris 1x2Ocy Roil Off lit..u-c.g- Is-1-3V1 V RES PO# 20-003-07162 ERO Book In Vedas: Weer proper • OSHA reprond PPE Whin hariceina to USE ECObay Waste Stream #070296892-0 '1".;A44- -D n511 molt*, on MI rnanlatt Johl 400.13_28022 16. GENERATOR'S/OFFEROR'S CERTIFICATION: I hereby declare that the contents of this consig nment are fully and accurately described above by the proper shipping name, ant are classified. packaged, matted 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 f am the Primary , Exporter, I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Conisent I certify that the waste minimization statement identified in 40 CFR 262.27(5) (if I am a large quantity generator) or (b) (if I am a small q uantity g eneratcr) is true. I Generator's/Offeror's Printed/Typed Name f.-1,,,cr- Signature Month Day (Year tho..1 E.i-..4-4.4...r- or __--,,. _ _ , ...._ I Sr I 21-1 I ',Z4• r, 1- ..?.. International Shipments Import to U.S. II Export from U.S. Port of entry/exit Transporter signature (for exports only): Date leaving U.S.: TRANSPORTER Transporter Acknowledgment of Receipt of Materials I Transporter 1 Printed/Typed Name Signature Month Day i f-Y-Dkj, -Et-vps•E---/ 1 1 i 7-5 i I Year Re Transporter 2 Printed/Typed Name ./ Si g ns Month Day I I I I I 1Year DESIGNATED FACILITY Discrepancy 1 18a: Discrepancy Indication Space •LI Quantity ElTyp0 Iiil Residue Pedal Reieclion ED Full RejectiOn Manifest Reference Number : 18b.Atemate Facility (or Generator) U.S. EPA ID Number • • • Facility's Phone: I I 18c. Sig nature of Atemate Facility (or Generator) Month Day I I Year Hazardous Waste Report Manag ement Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) -1, 2. 3. 4. Desig nated Facility Owner or Operator: Certification of receipt of hazardous materials covered by the manifest except as ncted In Item 18a Printed1-25NrnOck\\C-\_.) S : • - • lb I ' 8 Day Year - 1 747 17Z-C2