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} <br /> Please print or type, Farm Approved.OMB No.2050-0039 <br /> UNIFORM HAIAROOUS 1•Generator ID Humber 2.Page 1 of 3. R s 4.Manifest Tracking Number <br /> WASTE MANIFEST CRL 400 280 768 1 9w 1 020592163 JJ K <br /> 5.Uwe tors Name and Mallin Address Generators Site Address(if different than mail n address <br /> 25 NORTH ACIFI A 6425-NORTH PACIFI8 AVEC. <br /> ATfN:FUELS-'ATIQN MANAGER <br /> STOCKTON; 95207 STOCKTON,CA-95207 <br /> Generators Phone: (209)472-6600 <br /> 6.Transporter 1 Company Name 'U.S.EPA ID Number <br /> EO INDUS TF IRL SERVWES MIK 435 642 742 <br /> 7.Transporter 2 Company N me 'U.S.EPA I Number <br /> EEU ROCK IN9.DBA TSMTCO MOD 095 038 998 <br /> 8.Designated Facility Name and Site Address US ECOLOGY IDAHO,INC. U.S.EPA ID Number <br /> 2N00 LEMLE1Ij ROAD IDD 073114 654 <br /> GRAND VIEW,ID 83624 <br /> Facility's Phone: (800 274-9511$ <br /> ga. 0b.U.S.DDT Descriptio (including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11:Total 12,Unit 13.Waste Codes <br /> HM and Packing Group(if an)) No.: Type Quantity AMIVOL <br /> oX 1 RQ,UN19S3,Waste Flammable Liquids.n.o.s, Gasoline, 001 DM 00096 P DOD Doi 35 <br /> 0 "Diesel,3,P 11,(RQ:DDI$),ERG#128 <br /> ]{ Dtd3176 Solids Containing flammable liquid,n.o.s.(Gasoline, 001 DM 00086 ' P 35 REC <br /> Diesel)„4`.1 PG II,ERG#133 <br /> . 3 ` <br /> a. E <br /> I <br /> latsp�I� I�r wa ice' � II� �UiDMUD FUEL STATION WASTE 2.ABSNHWFS2 IAOSN14WFS2-DRW NEED FUEL FILTERS/ <br /> Excluded Rncycbblia atefial(Draifted Fuel Filtrats)IT:14.19.75752.121 <br /> L4 0�]2)(AP <br /> 15. GENERATOWSIOFFERORS CERTINCAMON:I hereby declare that the contents of this consignment are fully and accuratety described above by Bre proper shipping name,and are classified,packaged, <br /> marked and Iabeledlpla6rd A,and are in all respects in proper oondition for transport according to applicable international and national governmental regulations.If export shipment and I am the Primary <br /> Exporter,I certify that the co itents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. <br /> 1 certify that the waste minirrlization statement Identified in 40 CFR 262.27(a)(f I am a large quantity generator)or(b){f I am a small quantity generator)is true. <br /> [6;ZTatoes10ffeme <br /> ntedrryped Name Signature Mang Day Year <br /> ori 12� o � J 20 <br /> - <br /> ,j 16.Intemational shipments <br /> p_ ❑Import to U.S. ❑Export from U.S. Pat of entrylexit <br /> 3 Transporter signature(for expot only): Date leaving U.S.: <br /> UJ 17.Transporter Admowledgment Receipt of Materials <br /> a er 1 Printedlfyped Namj Signa Month Day Year <br /> � ! cora �. 0 9 20 <br /> a Transporter 2 Printedffyped Nam@ L LT-0 <br /> L Signature Month Day Y r <br /> F- <br /> 1312- <br /> 18. <br /> -18.Discrepancy 1 <br /> 18a.Discrepancy Indication Spa ❑ ouantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U,8,EPA I Number <br /> J <br /> U <br /> LL <br /> Facility's Phone: <br /> C3 18c Signahrre ofAltemate Facili (or Generator) ktarrlh Day Year <br /> d <br /> N1g.Hazardous Waste Report Management Method Codes(.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> Uj ' H14t k 2. H149 3. a. <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the maddest except as nded in Item 18a <br /> Printedrryped Name �Wiw <br /> Signature A-h�?Iaw Mont D y Year <br /> EPA Farm 8700-22(Rev.12-17) 1 revious editions are obsolete. E IGNt!7� <br /> 1LITY TO EPA's f3-MA FE SYSTEM <br />