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Please print or type.(Form designed for use on elite(12-pitch)typewriter.) 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 CAL000225782 1 800-424-9300 000811521 F L E <br /> 5.Generators Name and Mailing AddressGenerator's Site Address(it different than mailing address) <br /> BP West Coast Products, LLC 05489 <br /> P.O. Box 80249 130 S WLSON WAY <br /> Rancho Santa Margarita, CA 92588 94J-480-5200 STOCKTON, CA 95205 <br /> Generators Phone: <br /> ransporter 1 Company Name U.S.EPA ID Number <br /> BELSHI RE CARD00183913 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> OKD 1,91 $$-I <br /> 8.Designated Facility Name and SI Address U.S.EPA ID Number <br /> US Ecology. Nevada Operations <br /> Highway 95, 12 miles S. of Beatty NVT33001OGM <br /> Bq ast�ne: 89003 775-$53-2203 <br /> 9a, 9b.U.S.DOTI Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Tom 12.Unit 13.Waste Codes <br /> HM and Packing Group(Bany)) No. Type Quantity WtNoI. <br /> 1. NEW <br /> o Nan-RCRA Hazardous Waste, Solid 01111111107P 811 <br /> z NSIM <br /> 2. <br /> w <br /> c9 <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional Information FOLD LABEL AT Of <br /> WEAR ALL APPROPRIATE SESI:147848 Ll AFFIX TO I <br /> PERSONAL PROTECTIVE S@E._.oF,AAiAi� ' <br /> 33'C=i� —�o 7 EQUIPMENT. INxrEAuuBriLSSD <br /> TAB VIII OUF. <br /> _nirsar ossa:moi <br /> 15. GEN ERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, <br /> marked and labeledlplacarded,and are in all respects in proper condition for transport according to applicable international and ' a mmental regulations.If export shipment and I am the Primary <br /> Exporter,I certiry that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Conse . <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I a small qu dty generator)is true <br /> enera s10 ercr's nnte yped Name a gna urs Month L'ay yX <br /> Larry Moothart of IDES! on behalf of generator <br /> J 16.International Shipments <br /> Z11 Import to U.S. ❑Export from U.S. rt ty(exik <br /> Transporter signature for exports only). D to w U.S.: <br /> 17.Transporter Acknowiedgment of Receipt of Materials <br /> Transporter 1 Pr ntedliyped Name SignatureMcn h ay Ye <br /> aT ansporter 2 P ntedlfyped Name gigrature Month Day ar <br /> 18.Discrepancy ((��; I�I <br /> 18a.Discrepancy Indication Space Quantity ❑Type U Residue L_:Partial Rejection ❑Fuli Rejection <br /> Manifest Reference Number. <br /> 18b Alternate Fachty(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> Q <br /> w <br /> Facility's Phone: <br /> W 18c.Signature ofAitemate Facility(or Generator) Month Day Year <br /> 2 <br /> S2 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> p 1. 2. ` 3. / 4. <br /> i <br /> 20.Designated Facility Owner or Operator.Certification of receipt of hazardous materials covered by the manifest except as rated in Mem 18a — <br /> PdntedlTyped Name Signature Month Day <br /> EPA Farm 8700-22(Rev.3-05) Previous editions are obsolete. <br /> DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />