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Please print or type ce 0 ..„.1- 2 Z w CI 'I UNIFORM HAZARDOUS WASTE MANIFEST 1. Generator ID Number CAC00307R682 2 Page I of I 3. Emergency Response Phone Ann-fisfi-qnqn rOM1 Approve.a. UMb NO. 20b(.1-0039 4. Manifest Tracking Number 020 6231 01 JJ K Generator's Name and Mailing Address Generator's Site Address (if different than mailing address) JB Hunt 615 JB Hunt Corporate Dr Lowell AR 72745 Arch Rd and Logistics Dr Generator's Phone: 479-820-0000 - I Stockton, CA 95215 Transporter I Company Name US. EPA ID Number Ancon Marine I CAD980737068 Transporter 2 Company Name U.S EPA ID Number I Designated Facility Maine and Site Address U.S. EPA ID Number US Ecology Highway 95, 11 miles South of Beatty, NV, Beatty, NV 89003 Facilitys Phone: (775) 553-2203 I Aftrr:130010(100 ga. 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Containers 11. Total 12. Unit FDA and Packing Group (if any)) No. Type Quantity Wt.Nol. 13. Waste Codes 1 Non RCRA Hazardous Waste Solid (Diesel Fuel, Debrls) 352 111 1 CM 20 Y 2 3 4. 14. Special Handling Instructions and Additional Information 1. ERG 171 Debris 1x20cy Roll Off PES PON 20-003-07162 ERG Book In Vehicle: Weer moor 087iA approved PPE Whin hendlino be US Ecology Waste Stream # 070296892-0 mettles on this manifest Jobil 400.13.28022 IS GENERATOR'S/OF FEROR'S CERTIFICATION: thereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name, ant are classified, packaged, marked and labeled/placarded, and are in at respects in proper condition for transport according to applicable international and national governmental regulations. if export shipment and tarn the Primary Exporter, I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a) (ill am a large quantity generator) or (b) (if I am a srnall quantity generator) is true. Generator's/Offeror's Printed/Typed Name cle.-.1 Fir:A-104,4r D;.- ja, f-164 ,..ri- Signature ... _- - Month Day Year ••1-61 -7T-14.1 International Shipments ----'" Import to U.S. Export from U.S. • - Port of entry/exit: r- -?. Transporter signature (for exports only). Date leaving US.: ux P.- 27 (i) ., Transporter Acknowledgment of Receipt of Materials Transporter I Printed/Typed Name Signature ir6ON DE,e'lczf, _ transponer 2 Printed/Typed Name sigCe — Month Day Year 5" I'25 I z * Month Day Year I I I I )FAC ILITY - Discrepancy Discrepancy Indication Space Quantity Type LI Residue LI Partial Rejection Full Rejection Manifest Reference Number: Alternate Facility (or Generator) U.S. EPA ID Number Phone: I 1- DESIGNATEI Signature of Alternate Facihty (or Generator) Month Day Year I I Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, arid recycling systems) 2. 3. 4. Designated Facility Owner or Operator. Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Name Signature Month Day Year I I I I EPA Form 8700-22 (Rev. 12-17) Previous editions are obsolete. DESIGNATED FACILITY TO EPA's O-MANIFEST SYSTEM