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Plea�UNIFORM <br /> of . Form deelpned for use on elite(12-pitch)typewriter.) Form Approved.OMB No.20500039 r <br /> HAZARDOUS 1.Generator lO Number 2.Pagel of 3.EmafgemyReepopse Phone 4.Men011oalTracking�m4911 FLE <br /> STE MANIFEST CAL 0 0 0 4 1 2 5 D 2 1 800 9�4-9300 gg11.. 49 <br /> 6.Ganem ars ems and Mouinghadresse Densmore cars Adorns in W erant mar mpiling addmss <br /> Colonial Energy, LLC Colonial Energy 40135 <br /> 2860 N. Santiago Blvd. 14000 E Highway 58 <br /> suite 200 Loeke£ord, CA 95237 <br /> Ga�ia7ioAc;CA 92067 141 761-5926 <br /> 6: rensponer ompany ams . .EPA DNumOar <br /> Mnspoaar2 Company Name U.S.EPAIDNumv, <br /> i <br /> 6:Designated Fnallty Now arad Silo Address U.B:EPA ID Ndntber <br /> i�{ S. Eco gy Neyada Oper2tione N V T3 3 0 0 1 0 0 0 0 <br /> Beattyy NV' e90p31es S_ o Batty <br /> Fault 'd Phone 775 553-2203 <br /> 98. So,US.DOT Description(Including Proper Shlpprq Name,Hamrd Clan,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes <br /> HM and Pending Group(If any)) No, Type Quardi WVM. <br /> cr 1. Non-RCRA Hazardous Waster Solid (ERG #171) P 352 *DO 15 <br /> o (Rags, absorbent. a debris impacted with I \M 1 <br /> petroleum hydrocarbons) <br /> w <br /> I <br /> 3. <br /> i <br /> i ' <br /> 4. <br /> 14.Special ening hswcttdns end dtlNano In Orme on wrAR ALL APPROPRIATE BESI • „7 933 98 <br /> Generator is a RCRA VSOG as defined in PERSONAL PROTECTIVE COLONIAL CCN: 659236 <br /> 90 CPR 260.10. D016 code represents CLOTHING. <br /> waste that is RCRA identified but not <br /> RCRA regulated. PROFILE # 070214257-0. All <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION:I hereby declare that me conteds of this COnslgnmepl are fully and ewuratelydeecihed Shove by Ne proper shipping nam°,endare clessll packaged, <br /> mad(ed and labeled/placarded,and are In all respects in proper candldon for transport according to applicable International and national govemmenml regulations.If export shipment and 1 set the Primery <br /> Exporter,I coolly that the contents of this consignment conform to the terms of me attached EPAAcknowledgment of Consenl. <br /> I cor6ty that Ne waste mmanlzaUon statement Identified In 40 CFR 202.27(a)(il l am a large quantitygonemtor) b Tf I an!)smell quently generalor) We. <br /> erelo osP m YD° . a euro ay car <br /> 16• �IernaUona Shl a la ❑Impart lc Us. ❑Export Irom U.S. ort olalgryhxlk I. <br /> Tlona riots velum tar ak its Deb le U.9,: t <br /> 17.TranspoderAcknnxledgment of Receipt of Mall I <br /> renmorter blyranum Day ser <br /> 8 Tsmzporlor 2Pdnled7fype4 Noma aura Moral uny ear <br /> I <br /> 4. 10.Discrepancy <br /> 1B°,01°crepancy Indication Space ❑quantity [--]Type ❑Resldu° ❑PeNeIReJadkn ❑Full ReJecllon <br /> Marti)sl Reference Number: <br /> 18b.Alternate Fecfilty(or Generator) U.S.EPAID Number <br /> U i <br /> LL Facilll.°Phone: <br /> Oa'Slpnalara df Ilemete FQdllly(ar Generator) MobW Day Year <br /> z <br /> 19.Haeardops Wools Report Atanagatnanl Method Codas(i.e.,cadeda hezesdouavezla boalmonl,disposed,eM Ie4ytl18A ryslaina) <br /> 01• I- 2' 3. 4. <br /> 20;poslgne-d Fed My Owrzrs Opemto Corti caUonofa"plofhazardousmaterielscoveredby Ute mamiss[except es.rated In Item 18e C <br /> 1 <br /> ZM70022(RiB,EYPIA .m305dDESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) I <br /> i� <br />