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Please prirtt Or type. Form Approved, OMB NO. 2050-0039 <br />tx <br />0 ,i- <br />a w z 11.1 a <br />UNIFORM HAZARDOUS <br />WASTE MANIFEST <br />1. Generator ID Number <br />C A C 0 0 3130511 <br />—2. Page 1 of <br />i <br />3. Ernergercy Response Phone <br />44-334-2468 <br />4. blandest TracIdng Number <br />023134172 JJK <br />5. Generator's Narne and Mng Address Generators Ste Address (11 different than mailing address) <br />PG&E MANIFESTS PG&E STOCKTON <br />P.O. BOX 7040 1040 S. WILSON WAY <br />SAN FRANCISCO CA 4120 rTOCKTON CA P52{15 <br />Generator's Phone: 2 g 3 7 I 0 8 1 7 - 0 <br />E Transporter 1 Company Name - U.S. EPA ID Number .. <br />PSC INDUSTRIAL OUTSOURCING, LP 1:',AR000201:154 8 <br />Transporter Z Company Name U.S. EPA ID Number <br />1 <br />Designated Facility Name and Site Address U.S. EPA ID Number <br />US ECOLOGY NEVADA <br />HWY 05 11M1 S OF BEAT1Y <br />9EATTY NV 80003 <br />Facility's Phone:77 5 551- 72 rn . I*4 V T 3 3 0 0 1 0 0 0 0 <br />ga. 9b. U.S. DOT Desaipton (incti.kfing Proper Shipping Name, Hazard Class, ID Number. ID. Containers at Total 12. UNt 13. Waste Codes EM and Packing GrouP Of arlY0 No. Typo Quantity Wt.Nol. <br />X <br />NON-RCRA HAZARDOUS WASTE SOLID (PCD CONTAMINATED <br />DEER'S WT1-1 850PPM)' 201 SOILAND <br />a I CM / 55 66 1i <br />2. ... <br />, <br />4. <br />• <br />14. Special Handling Instructions and Additional Information <br />PROFILE # 070,304260-0 .._.- , <br />• <br />JOB li 178-2001-0002-32091 . <br />e-c3t-al JOB# <br />15. GENERATORS/OFFERORS CERTIFICATION: I hereby dedare that the contents of this consignment are Illy and accurately described above by the proper shipping name, ant are clawfied, packaged, <br />malted and Labeled/placarded. and are in all respects In proper condition for transport according to applimble internadona1 and cabanal governmental reguLaticos It wort shipment and lam the Primary <br />Exporter, I certify that the =tents of this consignment conform to the terms of the attached EPA Actiowledrent of Consent. <br />I certify that the waste mix*nizstion statement identihed 8, 45 CFR 26227(a) (ii I we a large clean tly generator) cr (b) fill we a srod quarrty generator) in true. <br />Generater's/Offercr's Printed/Typed Nameav ReAr4.441,- cy F.. Pe'or.... Signattre Month Day Year <br />-1--,......., z4:3......,.....„3- _ ......,,,......._ loriag-ix <br />_1 IC hie rnatonal Shipments <br />Import to US, D Export t6. Pat of erdrylaxih <br />Transporter signature (for exports only): Date leaving U.S.: !TRANSPORTER 1 17. Transporter Acknrwledgment of Receipt of Materials <br />Transporter 1 PrIntect/Typed Name SIgna . Month Day Year <br />OP.;.4 11144.5 I OS- 113-) ...7)--; ,,,k, , __I__.:= <br />Transporter 2 PrIntediTyped Name -- alum Month Day Year <br />I I I I 4----- DESIGNATED FACILITY --I' 18.13iscropency <br />tea. Discrepancy Indication Space LII Duality Type El Residue <br />. Manffest Reference Number: <br />II Partial Rejection Full Rejection <br />18b.Altemate Facility (or Generator) U.S. EPA ID Number <br />FaciDlys Phone: I <br />16o. Signature of Alternate FaciOty (or Generator) Month Day Year <br />I I <br />Hazardous Waste Report Management Method Codes {Le , codes for hazardous waste treatment, disposal, and recycling systems) <br />1. 01,5 A, 2. 13, 4. <br />Designated Facay Owner a Operatcs: Certficabon of receipt or hazard:us mated& covered by the manifest esoept as nctect 81 [tern 18a <br />Printed/Typed Name tit ja okt <br />offn v. -1 ous editions are obsolete. ED FACILITY TO EPA's e-MANIFEST S