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Please print or type. Form Approved.0 M B No.2050.0039 <br /> UNIFORM HAZARDOUS 1•Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Ma nifest Trac ki n g Number <br /> WASTE MANIFEST CAD980814800 I A 88&785-7225 016503859 F L E <br /> 5.Generators Name and Mailing Address Generators Site Address(if different than mailing address) <br /> JR Simplot Co. <br /> 15777 Howland Rd. <br /> Lathrop, CA 95330 <br /> Generator's Phone:2094,58.6470 <br /> 6.Transporter 3 Camny Name U.S.EPA ID Number <br /> Acl�enced Criemical Transport Inc./DBA ACTemAro CAROOM70540 <br /> 75nv ronmena�y anagement Technologies U.S.EPA ID Number CAR000183574 <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number <br /> ENronmentat Waste Solutions A2R000520478 <br /> 31915 Industrial Ln. <br /> Parker South AZ 85344 <br /> Facility's Phone: 8h-227-0189 <br /> ga 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit <br /> HM and Packing Group(if any)) No. Type Quantity Wtfikl, 13.Waste Codes <br /> x 'Non-RCRA Hazardous Waste Solid(Oily Debris) I]M P 352 <br /> Q _ <br /> 2Non RC17A Hazardous Waste Solid(Sludge) DIM � �7 P 491 <br /> 0 ! 7 <br /> 3;Non-RURA Hazardous Waste5ohil(Sand, us o ax 352 <br /> DF P <br /> 4. <br /> 14-Special Handling Instructions and Additional Information Project Number 3621-72 Documsnt <br /> 1} EWS6968 ARE-/u'-/CZ ZA-.ss DM 3) EWS15025 JRE-10q 7- <br /> 2) <br /> 2) EWS14222 JRE- /C t �.rc1L <br /> 15, GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare(hal the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, <br /> marked and Iabeledlplacarded,and are in all respects in proper condition for transport according to applicable international and national govemmenlal 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 E PA Acknowledgment of Consenl. <br /> I certify(hat the waste minimizalian statement identified in 40 CFR 26227(a)(if I am a large quantity generator)or(b)(if I am a small quantity generator)is true- <br /> Generato' r Prinledlfyped Name Signature Month Day Year <br /> 1 )5� , 1 4— Pfv:::g <br /> 18-InomMion 3Wments. <br /> F— ❑Import to U.S- Exporl from U.S. Port of entrylexit. <br /> ? Transporter signature(for exports only): Date leaving U.S.: <br /> W 17.Transporter Ack edgment of Receipt of NUAs <br /> OTransporter 1 nled ed NaUVtu Signature Month Day Year <br /> Q +J <br /> x Transp Prin yped Na signat a Ma b y Year <br /> kv, (L <br /> 18.&Nrepancy <br /> 18a-Discrepancy Indication Space ❑ Quantily ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> 18U.Alternate Facility(or Generator) U-S.EPA ID Number <br /> U <br /> LL Facility's Phone: <br /> Lu 18c-Signature of Alternate Facility(or Generator) Month Day Year <br /> 4 <br /> 2 <br /> 19-Hazardous Waste Report Management Method Codes(i.e-,codes for hazardous waste trealmernt,disposal,and recycling systems) <br /> � 1. � 2. �I 3- � 4. <br /> 20-Designated Facility Owner or Operator:Certification of receipt of hazardous`1 -L materials covered by the manifest except as mAd in Item 18a <br />' r <br /> Typed Name Signature Month Day Year <br /> fYYV�l - �- Lt I 3 <br /> EPA Form 8700.22{Rev.1Y 1 Previous editions are obsolete. DES NATER FACILITY TO EPA's e-MANIF EST SYSTEM <br />