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Please prim Or We.(Form designee far use on elite 12-pltch)typewrigar,) <br /> UNIFORM HAZARDOUS 1 Ganemlw lD NunOer Form Approved.OMS No.205G-G�'?i <br /> 1.Page i of 3.Emergerv:y Response Phooe 4. nileal Trackin§4645 <br /> Number <br /> WASTE MANIFEST 110 4 6 4 5 FL E <br /> 5.Generalo s Um,.d Mai ng Ad" Generatpfs k ddress(ifdMerenl Pian maip <br /> Pacfic Southwest Container �atltlfP55j <br /> 4343 E. Fremont Street <br /> S�tlo—ck�tThbri 95215 <br /> rerspOrter —'any alma <br /> Adlenced Chemical Transport Inc. (SV) U.S.EPA ID Number <br /> 7.Tranayaler2 parry Name CAR000070540 <br /> US.EPA ID Number <br /> 8.Desgnated Fai Name and ion Address <br /> US Ecology Nevada Inc U.S.EPA IDNumber --- <br /> PO Box 578 tl.�9S`,11 Miles S Beatty N\/T330010000 <br /> Beatty, w t�90(13 <br /> Fac' s PMrss: T7 2203 <br /> Be <br /> 9d.U.S.DOT Descnplkn(IndudinA Pi Shipping Name,Hazard Class,ID Number 10.Cordialness <br /> HM andP pgGra:P(ileny)) 11.TOW 12.Unit 13.Waste Coda¢ <br /> No. Type Quantity Vi <br /> .X ' " -t Corrosive liquid ba sir ' <br /> X <br /> 2 <br /> Id basic,inorganic,n.os_ <br /> ( •odium metasilicate pent drate), 122. <br /> PGR <br /> 3.tiW �R N H-r�rz Iqe a�P�j L-fil ya <br /> 1�R�{atc caarsivti� � � �F I ZC� � -- <br /> 4. <br /> 14.Special Handal;IMMUChOna era Atldilional Inkrmaeon <br /> Project Number 144083 Document# D172831 <br /> 2)ERG*LU; a2UmIW2312 aeI I_ ,3"I"'0'3'O 12Qffop— ler 15 — CAt 1 X-jSbT� <br /> 78, GENERATOR'S10FFEROR'S CERTInd am In it may T hereby tletlare Nal Ne contents d tllb consigrment are Wllyand accwakI i tlescribad above by the proper shipping name,arm are panned,packages. <br /> marked and Iabetedrplawmkd,and am In all reapads In Proper mndtion Ion treneporl arcading to applicable interregional and national v <br /> Exporter,I Candy pas Na Wntenls of this ilmmgnment ocnlorm to the farms of the apached EPAArArlod go emmemal regWations.11 expwl sNpmera and l am the Primary <br /> I artily that Na Waste mwi m ani"appMs iden8fied in 40 CFR 26227 a it I am a edsarlaN Of cc paint. <br /> reklsl o.s nledRypetl a ()I Iar9e puanary genarekr)a(b)of I am a small quantity 9"rator)is vue. <br /> `_ gnala4 <br /> X r'c G x Y ea: <br /> —s 1 .Intemaporel6hipmenfs )1 p� <br /> ❑ImPod to US. LJ Export Iran LLS. Pon of an r r <br /> Trans ars nature(fon on M eel <br /> w IT hanspoderAd_._nmenl d Reralpl of,,aepi U.S.: <br /> K TrcMWW 1 Prins ypetl Name <br /> O g a pre <br /> I aY ear <br /> aff reruporter2 Pdnle YMN., Signature Il O3 I� <br /> MADAM Day ea' <br /> 18.D'acrepancy <br /> Me.Discrepancy IMicari Space ❑ Qspi ❑Type <br /> El Residue ❑Partial Rejection ❑FWi Rejection <br /> f8b.A11emate FaWBy(w Garraalorl Mandril Relarence Nrmber. <br /> � U.S.EPA IO Numoar <br /> U <br /> a <br /> al Facdll 4 Ptrone: <br /> UU lk 'gnature of Allemme Facairy(w Genwalw) <br /> r <br /> z Year <br /> H19.Hazardous Waste RePon Mardegeman[Memod Cpdea BA,cadea for hazandouaw9ale reahnen <br /> c 1 1 S dappsel,and—All <br /> 9 syalany) <br /> 3. 4. <br /> 1 20 Des gnace0 Facility QWner or Ope a w Ce pfi a un of Mi of hazamees materiels covered by the als except as noted In Ilam 18, <br /> PrINadRyped alone <br /> Slgnatae DEPARTME 1"w °'y Year <br /> EPA Foran 8700-22(Ree3•05) P1e14111 editions 11 ohaolete. DESIGNATEDPACILITY IUDESTINATIONSTATE(IFI f4!Uh:,Irq <br />