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ForrniAooroved. OMB No. 2050-0039 I- lOGIOU <br />A <br />pun Ln anduL <br />UNIFORM HAZARDOUS <br />WASTE MANIFEST <br />1, Generator ID Number <br />C A C 0 0 3 1 2 7 1 6 9 <br />2. Page 1 of <br />,..44- <br />3. Emergency Response Phone <br />800-220-5252 <br />4. Manifest Tracking Number <br />00 6 82 1 0 7 2 GBF <br />5. Generators Name and Mailing Address Generator's Site Address (if different than mailing address) <br />1-Force Freight T-Face Freight <br />1000 Semmes AVE 1000 Roth Rd <br />Richmond VA 23224 iLathrop CA 95231 <br />Generator's Phone R 5 S 3AS - 7S3A I <br />6 Transporter 1 Company Name U.S. EPA ID Number <br />NRC ENVIRONMENTAL SERVICES INC. IC AR 0 0 0 0 3 0 1 1 4 <br />7 Transporter 2 Company Name U.S. EPA ID Number <br />, <br />:-.."------&?..— —.1e,e4t4e*./e—• .,--/I/i e-r 14/v,ii/?S" - </ 0?.? 4 /- <br />8. Designated Facility Name and Site Address U S. EPA ID Number <br />US ECOLOGY NEVADA <br />HIGHWAY 95, 11 MILES SOUTH OF BEATTY <br />BEATTY NV B9003 <br />Facility's Phone: gnn 2a9 3943 1-N V T _3 -3 - 0 0 1 0 0 0 0 <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 />FiKA and Packing Group (if any)) No. Type Quantity Wt.A./ol. <br />re iYon-RCRA Ha2erdoue Waste Salld (PPE & Debrial 352 <br />CD ....1- <br />12 0 0 1 , DM • 00250 P <br />w Z ii.1 <br />2. <br />0 <br />3 <br />4. <br />14 Special Handling Instructions and Additional Information <br />JOb# -ET-94--- i IV 1 1 i g <br />Prnfilft t 07012H300 —27921 1 x 55 PON- 2 2111,IR <br />15. GENERATOR'SIOFFEROR'S CERTIFICATION: thereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name, aid 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 I am a large quantity generator) or (b) (dl am a small quantity generator) Is true. <br />GeneratorAerors PrintedrTypec Na _ Signature Math Day Year <br />64 Agr"-: 7 &LAI 02- I <br />I -7 ....--Th------ <br />Pli 191)4 <br />...1 16 International Shipments Export from U.S. Port of entry/exit: <br />r— Import to U.S. <br />Transporter signature (for exports only): Date leaving U.S.: IRANSIMITER 1 17. Transporter Acknowledgment of Receipt of Materials <br />Transporter 1 Printed/Typed Name Signature — Month Day Year <br />l 4 I Z Sri 2- 1 <br />co et 2 Pn Month Day Year <br />Transntedir eel N ame zi)a4iepeel Signature <br />1 Ze,k1 I? 1 61 I A e"" - DESIGNATED FACILITY --0- II 18. Discrepancy <br />r____, <br />15a. Discrepancy Indication Space Li Quantity L__I Type Li Residue Li Partial Rejection 0 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. <br />\ <br />2. 3. <br />20. Des sled acility Owner or Operator. Certification ' of s materials covered by the manifest except as Item 18a <br />Printed/Typed Name P r Signature Mptrith Day Year <br />'1/1JkAn,e) AlIcIAN .i/rN\'`- IU WI <br /> <br />r A "II /TV Tr% GM A ,.-. - II! A MI._ C . CVCTCLI <br />EPA Form 8700-22 (Rev - 7) Previous editions re oötete.