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Please punt or typo. Form des!gned for use on elite(12-pitch)typewrlter.) Form Approvud,OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emer ency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST CAL 000 287 469 1 1 (954 993-953$ 016210237 JJ K <br /> 5.Generator's Name and Mail log Addrav yy�� TT MARINE�6 GeneraWss iilo Address Of dlflorontthan mailin.address) <br /> ATTENTION MARK HADL� 1810 FIELD AVE <br /> 500 WESTRIOGE DRIVE <br /> WATSONVIL E, CA 95076 STOCKTON, CA 95203 <br /> Generator's Phone: <br /> 6.Transportaf I Company Name U.S.EPA ID Number <br /> EQ INWSIRU SERVICES MIK 435 <br /> 7.Trpsporter 2 Company Name U.S.EPA ID Number <br /> B.Designated Facility Nnme and Site Address US ECOLOGY IDAHO, INC. U.S.EPA ID Number <br /> 20400 LEMLEY ROAD IDD 073 114 654 <br /> GRAND VIED,ID 83624 <br /> Far.ilit's Phone: (8014 274=151fi <br /> 9a, 9b.U.S.DOT 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. Type Quantity Wt.Nol. <br /> o X 1.UN 1013, Carbon Dioxide, 2.2,ERG#120 001 CY 00002 P 181 <br /> L X I"UN0312,Waste Cartridges,Signal, I AG, PG11, ERG*114 001 DF 00001 P D001 ! D003 D005 <br /> 141 <br /> 3 <br /> 4. t ' <br /> 14.Special Handling Instructions and Additional Information <br /> 1.WESTMI3/t.C2 Cylinders 2.WESTM23/SignaUSmoke Flares(7:14.14.51243.1( <br /> 15. GENERATOR'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 labeled/placarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations.If export shipment and I am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. <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 am a small quantity generator)is true. <br /> General sJOfferor's Printed/Typed Name sfgnatu r Month Day Year <br /> �X <br /> 1 05125 117 <br /> —J 16.Internaliunal5hfpments <br /> t` ElI <br /> Import to U.S. �J Export from U.S. Part of entry/exit: _ _ <br /> E Tfansporter s[gaatum(far expor[s only): Date leavra9 U.S.: <br /> W 17.Transporter Acknowledgment of Receipt of Materials <br /> Transporter 1 P'I VT ped Name Signature Month Day Year <br /> N 05 25 17 <br /> ZZ Transporter 2 Printed/Typed Name Signature Month Day Year <br /> fY <br /> H <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑Type L_1 j j.l Residue ❑Partial Rejection Full Rejection <br /> Man]fesl Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J_ <br /> V <br /> LL Fa+i[ily%Phone: <br /> W 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> Q <br /> Z <br /> N19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> LU 1 H132 2, H141 3. a <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> me pad Name r Sif{nat Month Day /Year <br /> f <br /> EPA Forrr18700-22(Rev.9-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />