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Please print or Form Approved. OMB No. 2050-0039 A ce 6) 2 z ut Cr, • UNIFORM HAZARDOUS WASTE MANIFEST 1. Generator ID Number CAC0 0 3 'I 3 E5 1 1 2. Page lot 1 3. Emergency Response Phone 844-334-2468 4. Manifest Tracklng Number 023134254 JJK Generator's Name and Malfing Address Generators Site Address (if different than mailing address) PG&E MANIFESTS PG&E STOCKTON P.0 BOX 7540 1040 S. WILSON VAY tee' IA/ /.',?(7. SAN FRANCISCO CA 04120 , STOCKTON CA 05205 Generator's Phone: 7 n n .), 2 q 0 9 1 T I .011 V .41115W7. ...14br TraesParter 1 Company Name ' U.S, AID Number PSC INDUSTRIAL OUTSOURCING, LP I CAR 0 0 0 2 El 9 5 4 9 Transporter 2 Company Name US. EPA ID Number 1 Designated Facility Name and SiteAddress 7..., D.S. EPA ID Number US ECOLOGY NEVADA -. HIAY 05 11MI S OF BEATTY BEATTY NV 3E03 Faserty's Pixone: 775 551 - 9 7 nl I NVT 3 3 0 0 1 0 00 0 ga. 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class ID Number, 10. Containers 11. Total 12. Unit 13.1Naste Codes Hm and Packing Group (deny)) N. Type Ostartiy WtiVol ‘ 1' NON-RCRA HAZARDOUS WASTE, SOLID (PCB CONTAMINATED 2E1 i sOlLAND DEEIRS WTH e5OPPM ) eitC), CM • "-- Special Handling instructions arid Additional Information PROFILE # 070309260-0 -fi713' 9-67--2/- JOB # 178-2001-0002-02091 A/1/. .10B-4 laeP7i) GENERATOROFFEROWS CERT1RICKRON: I hereby declare that the contents of this consignment ou-ellalF and accurately described above by the proper shipping name, ard am classified, packaged, marked and iabetedtplacarded, and are in all respects in proper condition for transport according to applicable Intemalionaland naticnal governmental regulaticas.11 export shipment and I am Ike Primary Exporter, I certify that tie content of this consignment conform to the terms of the attached EPA Admordedgment of Consent I certify that the waste rnintinizaticn statement identified in 40 CFR 262.27(a) (if I are a large quantity generator) or (b) (III are a small quantity generator) its true. Generators/Offerors Pr_.......>"tediT Naroe month Day Year .L4-1424Ale /dilittgnature _j r- E 15. Iniernatioifal Shipments Import to U.S. Export ton US. Port of entry/exit . Transporter signature (for exports oniy): Date leaving U.S.: r:d w Transporter Acknowledgment of Receipt of Materials TRANSPORT! Transporter 1 PnntediTyped Name Signature Month Day Year -V-.....--.......--2-1-P Transporter 2 Signature M r [th Day Year , i 1 I I I 4-- DESIGNATED FACILITY --* Discrepancy - 18a, Discrepancy InScation °•41.-ire Ei „jaw), I Tme Residue El ParEal ReOcrtat III .-- Manifest Reference Number Full Rejection lab. Alternate Facilny (a Generator) U.S. EPA ID Number Facility's Phone: I 18c Signature of PAernate Fatality (or Generator). Month Day Year I I IS. Hazardous Waste Report Management Method Codes (I.e., codes for hazardous waste treatment disposal, and recycling systems) 1. kktijt wi....L 2. 3. 4. Designated peaty orperat as noed in itern 18a Owner Occ on of receipt of hazardous materials covered by the manifest cox I 20. Certificati SgriatTa Month Day ..ty,.,,,c, rfNarc A 61- kia.„(6 I I I I Year lt I EPA Form 8700-22 (Rev. 12-17) vious editions are obsolete. DESIGNATED FACILITY TO EPA's e.MANIFEST SYSTEM