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Please print or type <br />Form Approved OMB No. 2050-0039 4 GENERATOR ) I UNIFORM HAZARDOUS I. Generator ID Number <br />CAC0030786147 WASTE MANIFEST 020623101 <br />2. Page 1 of <br />1 <br />3. Emergency Response Phone <br />£400-556-$1011() <br />4, Manifest Tracking Number <br />JJK <br />5. Generators Name and Math i g Address Generator's Site Address (if different than mailing address) <br />JB Hunt <br />615 JB Hunt Corporate Dr Lowell AR 72745 Arch Rd and Logistics Dr <br />Generator's Phone: 479-820-0000 - I Stockton, CA 95215 <br />6 Transporter 1 Company Name U.S. EPA ID Number <br />Ancon Marine I CAD980737068 <br />7 Transporter 2 Company Name U.S EPA ID Number <br />I <br />8. 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 />Facility's Phone: (775) 553-2203 I NV17430010000 <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 />HMand Packing Group cff any)) No. Type Quantity Wt.Nol. <br />1. Non RCRA Hazardous Waste Solid (Diesel Fuel, Debris) 352 <br />1 CM 20 Y <br />2 <br />3. <br />4 <br />14. Special Handling Instructions and Additional Information <br />1. ERG 171 Debris 1 x20ey Roil Off '10..k.icit- srs-; -3•V"; V <br />PES P( 20-003-07162 ERO SOok In Vehicle: Woe( proper <br />PPE When hereelrg he approval <br />-b,,,,04- -Dar) 511 this JOb# 400.13.28022 meted& on nemesia US Ecoloay Waste Stream *070296892-0 <br />15, GENERATORSIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name, arid 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 EPAAcknowledgment of Consent. <br />I certify that the waste minimization statement identified in 40 CFR 262.27(a) (if tarn a large quantity generator) or (b) (if I am a small quantity generator) is true. <br />Generator's/Offerors Printed/Typed Name ok-t Vc4- 144,_4= e.,-:- jEs t-1,4 ,,,-/- Signature Month Day Year <br />I e-_____- -- - -----;--c___ I I z L/ I V) <br />_i <br />i— <br />g <br />16 International Shipments _...------ <br />Export from U.S. Port of entry/exit: Import to U.S. <br />Transporter signature (for exports only) Date leaving U.S.: <br />Ce <br />i— re o Di <br />g <br />17. Transpoder Acknowledgment of Receipt of Materials <br />u..1 <br />Transporter 1 Pnnted/Typed Name Signature Month Day Year <br />1 W-13,0 Er-'N.P5E-/ I I I 25- I 2d <br />= Transporter 2 Printed/Typed NarTle i Signs Month Day Year po <br />I III I .4-- DESIGNATED FACILITY 18. Discrepancy <br />Discrepancy Indication Space Quantity Type LI 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 />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. Certification of receipt of hazardous materials covered by the manifest except as ncted in Item 18a <br />Printed4yM N Mad Day Year <br />,,,___________ <br />I 0 11CP I-4) <br />EPA Form 8700-22 (Rev 12-17) Previous editions are obsolete. s e-