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Please pnnt or type. Form Approved.OMB No,2050-0039 <br /> UNIFORM HAZARDOUS 1•Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST CAL000459525 1 888-785-7225 019'9 214 8 F L E <br /> 5-Generators Name and MaflingAddress Generator's 8ileAddress(if different than mailing address) <br /> Lustre-Cal LLC <br /> 715 South Gulld Are <br /> Lodi,CA 95240 <br /> Generators Phone:209-570-2515 <br /> 6.Trans omen 1 Cam n Name 11.5-EPA IO Number <br /> ANANCEf�W MICAL TRANSPORT LLC CAR000070MO <br /> 7.Transperter 2 Corn Name U.S.EPA ID Number <br /> LP, dare 2 <br /> 8.Designated Far'.ty Name and Site Address U U.S.EPA ID Number <br /> US Ecology Nmeda, Inc f' ,• N1/T33(3Q1E}t}a} <br /> Be t,,NM&f Sol Beatty <br /> .. <br /> Fadlhy's Phone: 22 3 I <br /> ga, gh-U.S.MT Description(nduding Proper Shipping Name,Hazard pass,ID Number, 10.Con:ainers 11.Total 12.Until 13.Waste Codes <br /> HM and Packing Group(if any)) No• Type Ouantity Wt1Vol. <br /> lNon-KURA Hazasdous Waste L.iqtdd(PaW sludge, ester GM P 343 491 <br /> 01 ZqLU <br /> � <br /> �. <br /> 3. i <br /> 4- <br /> 14.Special Handing Instructions and Additional Informaliom,. Rmiect KZ FuEr—5 rj D1Cu re>rt#: D731300 <br /> 1) 07D131570-2962 LUU- '—' X S P"k 4i <br /> 15. GENERATOR S+OFFEROR'S CERTIFICATION:I hereby declare that the cmtents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, <br /> marked and iabeledlplacafded,and are in all respects in proper condition for transport according to appiicab6e international and national governmental regulations-If export shipment and I am the Primary <br /> Exporter,I certly that the contents of tiffs mnsgmrenl conform to the terms of the attached EPAAchnoMedgment of ConsmL <br /> I certily that the waste minimization statement identified in 40 CFR 262.77(a)(if I am a targe quantity generator)or(b)(iI am a small quantity generator)is true. <br /> GeneralotsmForor's Printe(Typed Name Signature Month Day Year <br /> (� D f&2 <br /> 16.InternationalStdpm is ❑Import to U.S. ❑Export Irom U.S. t enlrylexit <br /> ? Transporter signature[for expof s on[y]: Date leaving U.S.: <br /> at w IT Transporter AdcnoWedgmentof Receipt of Matedals <br /> G~C Transporter 1 Printedffyped Name Signature Month Day Year <br /> 0. <br /> MTransporter 2 Pnntedliyped Name Signatwe Month Day Year <br /> Is-Discrepancy , <br /> t8a.Discrepancy Indication Space ❑Fu I Fie e-tion❑ Quantity Type Residue Partial Rejection j� <br /> Manifest Reference Number: <br /> 181b.Attemate Facility(or Generator) U.S.EPA ID Number <br /> r:J <br /> Fad itys Phone: <br /> 18c,Signature of Alternate Facility(or Generator) Month Day Yea' <br /> d <br /> a <br /> 19.Hazante Waste wn:Management Method Codes(l.s.,codes for hazardous waste treatment,disposal,and mgdN systems) <br /> T__ <br /> 4. <br /> 20.Designated Facility Owner or erator:Certifhcallan of re . of dcus materials covered by the manifest except as noted in I <br /> Printed(Typed Name Signalan <br /> :1A <br /> EPA Form 8700-22(Rev.12-17)'PreMl editOlVe obsolete. DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM <br />