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0 <br />Please print or type. (Form des <br />tUNIFORM HAZARDOUS <br />WASTE MANIFEST <br />for use on elite <br />.GeneretorsNameandMallingAddress R �t06434 <br />ATTN: STORE MANAGE AID <br />1710 CALIFORNIA ST <br />ESCALON, CA 95320 _ <br />6, <br />-, - - ��..�, ,.fes-��L��' �-��l.�L•�!� <br />CesNitiated Facility Name and SiteAddress US ECOLOGY IPDAHO., INC. <br />2M LEMLEY ROAD <br />MAND VIEK 10 83624 <br />04 1; PR LVI one 1=0 111 E 171 <br />III II I iiiiiiiiii iiiiii Jill III <br />i <br />1710 CALIFORNIA ST <br />ESCALON, CA 95320 <br />C� <br />t� 073114 t'�4 <br />it. Total 12. Unit 13. Waste Codes <br />Quantity WWoI. <br />Tsai <br />ti o <br />i. RA�f1 !t►,ei•�..�tst � fiX�9. f'r�'ssr L �. ii,�tEt9, ! ��i�+zea E.is: - N1P�ol�`, Pero;.i� 4, irt�'0�i / firer it:� Ct}tisrtcr l�sarrari�Rsc�l� - <br />F1eFA <br />15. GENERATOR'SIOFFEROR'S CERTIFICATION: t hereby declare thatthe contents of this consignment are fully and accurately described above by the proper shipping name, and are classified, packaged, <br />marked and labeledlpfacarded, and are in al respects in proper oopdigon fortransport according to applicable irdemationaland national governmental regulations. If export shipment and I am ths Primary <br />Exporter, I certifythatthe contents of this consignment conform to the terms of the aesched EPAAcknowledgment of Consent. <br />I eerbly that the waste midmtzatwn statement identified in 40 CFR 262.27(a) (if I am a large quanffty generator) or (b) (if l am a small quantity generator) is true. <br />Ak <br />Import to U.S. <br />17. TransporterAOknowledgment of Receipiof 071 11 I1S <br />Materials <br />18. Discrepancy <br />18a. Discrepancy Indication Space � Quantity <br />18b. Xtemats Facility (or Generator) <br />U <br />taa• FacilillPhone: <br />O 180. Signature ol'Altemate Facdity (or Generator <br />4 <br />19, Hazardous Waste Report Management Method Codes <br />LU 21 <br />HIM <br />a � • • � jr • ►fYfiil <br />d from U.S. Port of entrylexil: <br />Date leaving U.S.: <br />:.,codes (or traar'dous waste treatme)rk, disposal, and recydtng t <br />H141 1 <br />3. Hilo <br />materials covged by the manifest except aspAe <br />d in Item 18a <br />❑ Partial Rejection <br />H11C3 <br />0?Iii I iS <br />u Full Re)ecuon <br />editions areotrsolete. `" D)WSTGNATED FACI[.{TYTO DESTINATION STAT�(IF <br />