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Please print or type.(Form designed for use on elite(12-pitch)typewdlor.) Form Approved.OMS No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Genemlor ID Number 2.Pegs l of 3.Emogoncy Responu RxO— 4.Manifest TmchlnO Numhar <br /> WASTE MANIFEST C A L 0 0 0 4 1 2 5 0 2 1 (800) 924-9300 010629863 FLE <br /> 5,Gelumwa Name and mouirg Mtlmu GerennorszHueldamaekR2amn,amrearm address) <br /> Colonial Energy, LLC Colonial Energy 40136 ISI <br /> 2860 N. Santiago Blvd_ 14000 E Highway 88 <br /> Suite 200 Loekeford, CA 95237 <br /> Oca❑❑aac, CA 92867 (714) 761-5426 ' <br /> Genemlal4Pnon2: <br /> mmpanerl pang U.S.EPAW Number <br /> ams <br /> BELSHIREC ARO 0 0 1 8 3 9 13 <br /> F.Tiumperlar 2 Company Name U.S.EPAIO Number <br /> I <br /> 8.Oesignated Fadety Namo and Site Addmn U.S.EPA ID Number <br /> U.S_ Ecology Nevada Operations BVT330010000 <br /> Highway 95, 11 miles S_ of Beatty <br /> Beatty, NV 89003 <br /> Fadii'a phone! (775) 553-2203 <br /> ga. 9b.U.S.DOT Desugtleolemming PromrSNpping Nam,Hazard Class,ID Number, lo.Cum ners 11.16lal 12.Unit 13 Waste Codes <br /> HM and Fading Group(it any)) No. Type Ouamay R7NaL <br /> 1. Non–FICRA Hazardous Waste, Solid (ERG $171) 9 392 •D018 <br /> Q (Rags, absorbent, [ debris impacted with <br /> petrolatum hydrocarbons) <br /> �7 <br /> 2. <br /> _— <br /> I � <br /> 3. <br /> 4. <br /> 14.SpaddHanding Ins wa andNltld'andmmrmauon WEAR ALL APPROPRIATE BE31: 285973 <br /> Generator is a RCRA VSQG as defined in PERSONAL PROTECTIVE COLONIAL CCN: 659236 <br /> 40 CPA 260.10_ D018 code represents CLOTHING. <br /> waste that is RCRA identified but not PROFILE # 070219257-0 X <br /> RCRA regulated. 55 <br /> 15. GENERATOR'SfOFFEROR'SCERTIFICATION:Ihembydedam that am mdeMsdlsismngmarl sparely,and e<amlely described Shove by 9m proper shipping name,and are daulsed,pad2paa, <br /> marked em labe'ed'plamrded,and am In a0 respects In propermnds2n ror mnSpOrtMounting M apWAtelsinternational and nelond gw mnmlel mguhOom.Irexpert ardpmed and l am the PlMay <br /> Exporter,I mtgry that IN mnlanls of Ws mmignmeAt mnrorm to am lames of aaarhed EPAAd wwladgmmlorConsem. <br /> I mrWy vial the wean minirizagm Statement identified In 40 CFR 262.27(a)(tI am alarya quanea generator)or(b)(iI l am a small quantity generale)is hue. <br /> 0!5/0�mVs r�m-.LY�na ami \ � 2 f <br /> Maw uay Year <br /> aa <br /> J 16aaW suarrents . <br /> LL Impolb US. ❑Bpm!han U.S. Pmofedtylent: ._ <br /> Y <br /> Tronsoorteraranatum(fwexpads only): Date leavino U.S.: <br /> rc 17.TmepoAuAdumAdgmmtofRea'gtolMeleea!s <br /> Traluporler 1 PrmWWyped Nam, ne a aQ By er <br /> a Clue, <br /> LanspoAe2Pdnlodrtypad Nam, - gmnea on Y <br /> 4, 18.D'aoepmLy <br /> 182.Dhaepancy Indimon Spam ❑openrif, []Type El Rubin ❑path!Re)edmn ❑Fte Relecbon <br /> ManlfetReremmm Number: <br /> 1Sb.AlhxmleFea'Sry(a Genemla) U.S.EPA ID Number <br /> U <br /> LL <br /> t9 Fodid <br /> ISO,SgnPu <br /> Alternate Fadlity forGenammr) Morelli Day Year <br /> Q <br /> N19.HazerduusM310 Report Method Codes Re,miles lorherardaas wase aoalmem.dhposel,am,riming systems)M <br /> C1, i•a 2. 3. 4. <br /> 20.Designated Fadgy a0polelor.Cedfimtletol mcdpld rd0 is mdedersmxed by[her ee ole!In Ilam ase <br /> ' o teNTyped Name Syulum M1 oa <br /> ErP.�A FDrm8700-22(Rev.3A Previous edilians are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br /> -IvlbFf� <br /> 1(070-711 <br />