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Please print or type. Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2 Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST CM000285Z62 1 408-363-3678 0146 9 FLE <br /> 5,GNnrnalur's Name and Mailing Address Generalnr'e Sire kdrirr•;,(if different than milling addreas) <br /> [WTAL FINISHING SOLUTIONS - STOCKTON <br /> 1325 EL PINAL DRIVE <br /> STOCRIDN, CA 95205 <br /> Generator's Phone: -R25 A72—126-3 <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> 7.Transporter 2 Company Name U.S.EPA 0 Number <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number <br /> US ECOLOGY NEVADA <br /> SWT_ 95 it MII.ES SORTS OF BEATTl, P.0. BOX 578 <br /> BEATTY, N9 89003 <br /> Facility's Phone: _ <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 /> HM and Packing Group(if any)) No. Type Quantity Wt.Nol. <br /> 1 RCRA HAZARDOUS WASTE, SOLID (AL.II1�IHU1 ) 181 <br /> 0 BA P <br /> �a <br /> z 2 <br /> W <br /> c.7 <br /> 3. <br /> 4 <br /> 14.Special Handling Instructions and Addltlonal Information <br /> 1) 070128300- 29038 RINSE WATER FILTERS <br /> HILL TO ALL CLEAN PO# 18361 <br /> 15. GENERATOR'S/OFFEROR'S CERTIFICATION: i hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and 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 EPA Acknowledgment of Consent. <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if t am a large quantity generator)or(b)(if I am a small quantity generator)is true, <br /> Gerwral&VOfferor's Printed7yped Name Signature Monlh Day Year <br /> 16.Inammi0hal Shims" <br /> El Import to U.S. ❑Export from U.S. Port of entrylexit: <br /> K Transporter signature(for exports only): Date Ieaving U.S.. <br /> 17.Transporter Acknowledgment of Receipt of Materials <br /> 1i Transporter 1 P edlTyped Name Signature Month Day <br /> J ear <br /> OIL r.t <br /> Z Nrier 2 Phnt&rypifd NameIh Da ear <br /> mi l ivi//ialn s t - ®s rr2 �/h s ray �zLu, <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> 18h.Allernalo Facility(or Generator) U.S EPA ID Number <br /> J_ <br /> V <br /> LL Fecllity's.Phone <br /> w 18c.Signature of AHemate Facility(or Generator) Manlh Day Year <br /> Q <br /> Z <br /> Cn 19.Hazardous Waste Report Management Method Codes(i.e..codes for hazardous wasie lreatmeni,dlspuso,and reryoling systems) <br /> G 1 Wn- <br /> 2_ 3 4 <br /> 20.De gnaled Facility Owner or Operate.CerliCcation of roci of hazardws materials Covered by the manffeM except as noted in Ilem 18a <br /> PdaljicliPped Name signat P nth Day YOU <br /> fr]d} Z <br /> EPA Form 8700-22(Rev 1 T)#rrevious ed[lions Wobsolete. DESIGNATED FACILITY TO EPA's e•MAN FEST SYSTEM <br />