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Please 11nt.or type.(Form designed for use on elite(12•piich)t r. ~r f� f.''!_� I Form Approved.DMB No.2050-0039 <br /> UN3FORM NA�ARpQUS '1 Generator 10 Number 2'.Page 1 ai 3.Emergency Rwonse Phone 4,Manifest Tracklrrg Nurmbor _ <br /> WASTE MANIFEST CAL 000 287 489 0162A23 JJ K <br /> 5.A neral0is Naim.and k9ailing.gsldress 15 � 1810 FIE <br /> � Generators Site Address(if tlifferelrlthan mailing address) <br /> LD AVE <br /> SII _ <br /> �A 851D 6 GTOCKTC3hl, CA V)203 <br /> Gensrattir's Phone: <br /> 6.Twm". —1 Company Name U.S.EPA ID Number <br /> IMMTRIAL SERVICES 642 742 <br /> 7.Tmngxel r 2.Company Name U.S.EPA 1D Number <br /> 8.Designated Facility Name and Site Address U ECOLOGY IDAHO, INC- U.S.EPA ID Number <br /> 20400 LEMLEY ROAD IDD 071 114 654 <br /> GRAND VIEW, ID 83624 <br /> Facility's Phone: MM 274-1516 <br /> ga 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 /> 0 <br /> X 1-UN1013, Carbon Dioxide, 2.2, ERG#120 001 CY 00002 P 1„1 <br /> 2 X 2UN0412,VAMe Cartridges, Signal, 1.4G, PGII, ERG#114 031 DF 00001 P 0001 0003 x005 <br /> ia. 141 <br /> 3 <br /> 4 t <br /> 14.Spodal Handling Ir0watlorw pnd Addltlanxl Infgrrnat on. <br /> 1 WESTM'I','C.02'('yIirIfi0rs ? VV ES ,o --'i, Sig i,,o (1'14 14: 1':4” 1! <br /> 15. GENE RATOR'SfOFFEROR'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 /> rngked and labaledlplmarded,and are In all respects In proper condition for transport according to applicable intemational and national governmental regulations.If export shipment and I am the Primary <br /> Exporter,I certify that the contents of this consignment eenform to the terms of the attached EPA Acknowledgment of Comm. <br /> I certify that thewaste minimization statement identified in 40 CFR 262.27(a)(if.I am a large quantity generator)or(b)(if I am a small quantity ganeralor)is true. <br /> Generator'kOffero4PdntadlTypedName S natur� Month Day Year <br /> _r 16.lntematloryai Shipments <br /> ❑Import to U.S. ❑Export from U.S, Port of entry/exit: <br /> Transporlar slgnalure(for sxporls cinly): Date leaving U.S.: <br /> nC 17.Transporter Acknowledgment of Receipt of Materials <br /> TI' gporler 1 P n dfTyped Norm Signature <br /> Month Ray Year <br /> ` .. <br /> 1 �. cc 2 r <br /> J 1 <br /> Tronsporinr2 Printedfryped Name Signature Mnnlh Day Year <br /> I I <br /> ♦ 18,Discrepancy <br /> 18a,Discrepancy Indication Space ❑ Quantity ❑TypeJ j <br /> ❑Residue ❑Partial Re ection E,�Full Rejection <br /> Manifest Reference Number: <br /> 186.Altemafe Farllliy(or Gansratof) U.S.EPA ID Number <br /> y <br /> eai Facility's Phone: <br /> W f 8c. ignature of Altemats Faallty(or Generator) Month Day Year <br /> rn Ig-Hazaiduus Wasle Reporl Management Method Codes(ra codes for hazardous waste treatment,dlsp",and recycling gystorns) <br /> W <br /> rn <br /> 2. 3. I'l. <br /> F'r,"T <br /> d FacHity Owner or Operalor CfirGgcaticn of receipt of hazardous materials covered by the manifest except as,noted in Item 18a <br /> Nnrrrn ` Signature 1 r/ onlh Day Year <br /> EPA Form 8700.22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO GENE <br />