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Please prInt or type, Form Approved.OMB No.2050.0039 <br /> UNIFORM HAZARDOUS 1 Generator ID Number 2.Paye 1 0l 3.Emergency Response Phone 4.Manlfoel Tracking Number <br /> WASTE MANIFEST CAR 0 0 0 2 2 7 9 2 6 1 (800) 929-9300 012764864 ELE <br /> 5.Genumlofa Nanro and Melling Address G nerator's Silo A dross(if dllfomnl(han malRng d ens <br /> Costco Wholesale Corporation 4�ostco l)lolesale - 9VO KTOti - 0036 <br /> PO Box 80988 1616 East Hammer Lane <br /> Rancho Santa Margarita, CA 926 8 460-52pp Stockton, CA 95210 <br /> Ganerators Phone: <br /> 0.Transporter 1 Company Name U.S.EPA ID Number <br /> BELSHIRE CARO 0 0 1 8 3 9 13 <br /> 7.Transporter 2 Company Name U.S.EPA 10 Number <br /> 8.Designated Facility Name and SlteAddrees U.S.EPA ID Number <br /> HU.S. Ecoll9oo�gy Nevada Operations H V T3 3 0 0 1 0 0 0 0 <br /> Beattay, 9 , miles 5. of Beatty <br /> y, (775) 553-2203 <br /> FacRi s Phone: <br /> ga. 9b.U,S.OOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes <br /> HM and Packing Group(if any)) No. Typn Quantity WI Aro. <br /> 1. UN3175, Waste Solids Containing Flammable P 352 D018 <br /> p X Liquid, n.o.s., 9.1, PG II (Contains \ – <br /> Gasoline) <br /> z <br /> —T- <br /> W <br /> 3. <br /> 4, <br /> 14:Spedal-H ndfinglnslnrctfonsandA.ddillonalInformation WEAR ALL APPROPRIATE BESI : 298575 Fnl4 tffldl <br /> � �>•���' <br /> ERG#: 133 PROTECTIVE CLOTHING SIDE Of dN <br /> Absorbent, Filters, Debris Contaminated C09TC0 CCN: 685883 uTfA(i irw <br /> with Gasoline f v I_jA �u <br /> PROFILE # 07-012-8301-1785 //l <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION:I hereby ceclare that the contents of this consignment aro fully and accurately described above by the proper shipping name,and are classified,packaged, <br /> cc <br /> marked and labeled/placarded,and are in all respects In proper condition for transport aordirg to appl!cabie International and national governmental regulations.If export sNpmenl and I am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknoWGrIgment of Consent. <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(x)(if I am a large quantity generator)or(b)(if I am quantity generator)Is true. <br /> 7 <br /> rLnefator'rdOfferoes PrinladflWed Name Signaturerry Moothart of BEST on behalf of generator L_ <br /> 18.InlcYnalWnal Shipments El Import to U.S. 1 Exper,from U.S. Pod of entrylexiL <br /> ? Transporior slgnaturo(tnr oxports only): Date leaving U.S.; <br /> nt 17.TransporterAcknowledgment of Receipt of Material <br /> w <br /> L Tra," ler 1 PrinledlTypod N Signature btordh 133Y Year <br /> a <br /> aTransporter 2Printedrlype ma aSignature Month Day II Year <br /> 10.Discrepancy rr–� r—� <br /> 180.Dlsaopaney Indication Space Quanllly LJ Type D Reslduo ❑Partial Ro)oc8on L J Full Rojecl!on <br /> Mantled Reference Number. <br /> lob.Alternate Faclllty(or Generator) U.S.EPA ID Number <br /> J <br /> i <br /> V <br /> LL Facillly's Phone: h",crlh Uay Year <br /> C318c.Signature of Alternate Facility(or Generator <br /> Z <br /> Z <br /> y19.Hazardous Waste Report Management Method Codes(I.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> a 1 2 3. 4 <br /> 20.D Ignaled Fedlily Ovmer or Operela:r:odillcal(on of rerelpt of hazardous malerisis covomd by Ilw uyanllasl except os nde m 10u <br /> Si nnluroMonth DO Year <br /> Prin,erllfyped Name <br /> EPAFormm 8700-22(Rev. 2.1"1.11ar sole\►(o. J) c�NATEO FACILITY TO[PA's o MANIFEST SYSTEM <br /> Wn✓per <br /> JgO9 <br />