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Please print or type. Form Aonrovod. OMB NO 2050-0039 4 GENERATOR UNIFORM HAZARDOUS <br />WASTE MANIFEST <br />1 Generator ID Number <br />CAC003078687 <br />2. Page 1 of <br />1 <br />3. Emergency Response Phone <br />F100-55F-9ncir) <br />4. Manifest Tracking Number <br />020'..--:,.'3101 JJK <br />Generator's Name and Mailing Address Generator's Site Address (if different than mailing address) <br />J8 Hunt <br />615 JB Hunt Corporate Dr Lowell AR 72745 , ' Arch Rd arid Logistics Dr <br />Generator's Phone: 479-820-0000 - 1 Stockton, CA 95215 <br />Transporter 1 Comrry Name US.EPA ID Number <br />Ancor) tvthrine I CAD980731068 <br />Transporter 2 Compahy Name U.S. EPA ID NuMber <br />I <br />Facilit <br />B. Designated Facility Name and Site Address U.S. EPA ID Number <br />US Ecology <br />Highway 95, 11 miles South of Beatty, NV, Beatty, NV 89003 <br />'s Phone: (776) 553-2203 I Nkrrnoionnn <br />ga. 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Containers 11. Total 12. Unit Waste HM and Packing Group (if any)) No Type Quantity Wt.Nol. 13 Codes <br />1 Non RGRA Hazardous Waste Solid (Diesel Fuel, Debris) 352 <br />CM 20 <br /> <br />i <br /> <br />•• 1 i <br />.. , <br /> <br />14. Spedal Handling Instnictions and Addlional Information <br />1. ERG 1710iles 1a2Ocy Rrit Off p.toc.q. 851 3tlie <br />PE8 Pot 24803-07182 Ma flocit In WAWA*: 6,4 ccu p(tpor <br />0.11-lA arrnwrd PPE Whin hane.ing S'* <br />lin 11)..e." 7)3 n 51 40013.28022 Ecolaiv waste Stream I 07021)6892 -0 m000rligs al ttio er.arbilon Job/ <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, ard 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 lam 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 tam a large quantity generator) or (b) (if I am a small quantity generator) is true. <br />Generaters/011eror's Printed/Typed Name on1 illk4-1•44= or ...M. I- 1,4 r.ry- Signature Month Day Year <br />....., .....:..-- ....„,— -..----er. <br />I EP,- I if I 2 Li I <br />e <br />k <br />16. International Shipmkits Import to U.S. Export from U.S. Port of entry/exit: <br />Transporter signature (for exports only) Date leaving U.S.: TRANSPORTER 17. Transporter Acknowledgment of Receipt of Materials <br />Transporter 1 Printed/Typed Name Signature i . Month Day Year <br />....__ <br />y .),1 i . • ):. t-.... .; L / I I '' I 2 -) I 7 -' <br />Transporter 2 Printed/Typed Name Signature , Month Day Year <br />I I I I DESIGNATED FACILITY 18. Discrepancy <br />Discrepancy Indication Space El Quantity Li Type El Residue Partial Rejection Full Rejection <br />Manifest Reference Number <br />Alternate Facility (or Generator) U.S. EPA ID Number <br />Facility's Phone. ; I <br />18c Signature of Alternate Facility (or Generator) Month Day Year <br />I I <br />19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) <br />1. 2. 3. 4. <br />20. Designated Facility Owner or Operator Certifica 'on of receipt of hazardous materials covered by the manifest except as nded in Item 18a <br />Printed/Biped Name ky , , , . -...., _.-• — ,. ---, .. .\—q,-\1 V ., <br />1 Signature <br />i <br />/4111,Day Year <br />\\s <br />EPA Form 8700-22 (Rev. 12-17) Previous editions are obsolete. TRANSPORTER COPY