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P411 <br /> lease phnl or lype.' ;;R::-.. r• rt i., :L Form Approved.OMB No.2060-0039 <br /> UNIFORM HAZARDOUS 1,flenoralor ID Number 2.Pega 1�6f!'3.Emoboncy'Rosponse Phone 4.Man fest racking Number pp: " <br /> WASTE MANIFEST. C A L 0 0. 0 .0 0 g 9 33 . .1 1 00) 47,4-�9300 0 1 0 FL� <br /> 8,Generator's Name and Mailing Address 4 6ppdhoirralaeo SlloAddress If dlfferent than mailing address'1�f"4 <br /> .Quik Stop Mar'k6ta, Ino. 727k. ,IStowe p t��s>rkots, ink. <br /> 155 i8ndexe Road stckton, .CA' 9.5210 <br /> liestborough, 0158-1 <br /> Generator'sPhorle: (510)" 4d5-2202 <br /> 6,Transporter 1;Conrpany Name U.S.EPA ID Number <br /> ELUaHIRs . CaR0 0 01.0 3 913 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 6.Designated Facility Name and Site Address" U.S.EPAID Number <br /> U.s Et:ol ogy, -NeVada Operati6ne X V T 3 3 0 0.1 .0 0 O"0 . <br /> Highwily 95, 11 miles 6. of Beatty <br /> Matty,. -NV 89003 ' p1s) .553-.2203 <br /> Facili %Phone: <br /> 9a 9b-U.S,DOT Description(Including Proper Shlpping Name,Haiard Class,IA Number," 10,Contalners 11.Total" 12.Unit 13..Wasla Codes <br /> 'HM and Packing Group(if any)) No. Type Quantity '&Nol: <br /> 1• Non--RCRA. Hazardoun Nssl:ti, Solid . (NRa_ #171) G*4 p 352, Dole <br /> o (Rags- `"absorbent a dtebria impacted with <br /> pnaaco oum bydrocarbon6) , <br /> z 2: <br /> LU <br /> 4, <br /> 14.Spedal Handling Instructions andAdditionalInformation 1[1M ALL lI FWWR.IA'IH BEgI 3Q 6626 <br /> f�rrne=aGor is a RoitJ1 VBQQ as, def"ined in PlRaUNAL PJRG?R&IVR <br /> Ao CFR 260.iO. 0016 Code represents CL07HING QUIKBTOP ccH: 659231 <br /> waste that is KPIA identified but. not PROFILE 1 07tl21A2"a`7�0 <br /> RC" requLated. �. <br /> 15. GENERATOR'SfOFFEROR'S CERTIFICATION: I hereby dedare that the contents of this consignment are fully and accurately.described above by the proper shipping name,and are'dasslfied,packaged, <br /> marked and labeled/placarded,and are in all respects In proper condition for transport according to applicable international and natlonal governmental regulations.If export shlpment and I aro the Primary <br /> Exporter,I certify that the corilants of(his consignment conform to the terns of(he ailached EPAAcknowfedgment of Consent. <br /> I certify khal the waste minimizab'on statement IdenlMed in 40 6FR 26227(a)(if I am a large quantity generator)or(b)(ill am a small quantity generator)fs true, <br /> Generators/Offeror!s PrintedlTyped Name rs: r Signature f Month Day Year <br /> 16.Intemational Shipments <br /> r <br /> ❑Import to U.S. ❑Ekp.A fron!'U.S. Port of entrylexit: <br /> z Transporter signature(for exports only): . Dale leaving U.S-: ' <br /> of 17.TranspoMr Acknowledgment of R_ecelpl of Malerials <br /> WTransporterl Pdntedffypsd• are Signature {\ Mon�tK . Day Year' - <br /> Z Transporter 2 Prinledffyped Name Signature 'Month Day Year <br /> F r <br /> 18.Discrepancy <br /> 18a,Discrepancy Indication Space �luanli ty, <br /> ❑Type ❑Resitlue ❑Partial Rejection 'Dull Rejection - <br /> Manlfesl.Reference Number: <br /> 18b.Alternate Facility(or Generator) ` U.S.EPA ID Number <br /> LL Facility's Phone; <br /> w 18c.Signature of Allernale Faclity(or Generator) Month Day " Year <br /> 19."H6zardous Waste Report Management Method Codes(Le.�,codes for hazardous waste treatment,disposal;and recycling systems) . <br /> � 1 + 12; 3., 4. <br /> fq <br /> 20.Designated Facility Owner or Operator.Ceriffleation of recelp of hazardous melorials covered by the manifest except as noted In Item 18a.- ' <br /> Pdnte pe iVe a 1" Sgnatur Month Day" Year <br /> �. - ' }r <br /> EPA For 87 -22(Rev.12 7) Previous a Ilona are obsolete. `'�'" TRANSPORTER COPY <br /> 14'4/2974863 <br />