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Please prInt or type. Form designed for use on elite 12 itchtypewriter,) Form Approved.OMB No.2056-069 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.E�gr�e;±y fje�p�n^s�e5P3 n$e 4.Manifest Tracking kumuer <br /> WASTE MANIFEST CAL 000 287 468 2 SCJ � o 939 JJ K <br /> 5.Generator's Name and Nta11i Address VWST IMMNE A Generator's Site Address(if different than mailing addres, <br /> AATT>�f]NN 8 1810 FIELD AVE <br /> tf' TMSONVI If C 9540 6 STOMON, CA 95203 <br /> Generator's Phone: "4-M2 + <br /> 6.Transporter 1 Company Name U.S.EPA1D Ncimbor <br /> Eft*&VA'TR1AL�'R. Ims MK 435 642 747 <br /> 7.Transporter Comparry Nome U.S.EPA ID Number <br /> BED F W.WA TWTICA MW Oma 038 <br /> B.Designated Facility Name and Site Address U.S.EPA ID Number <br /> 20+11]0 LE01Al.EY ROAD 10D ECOLOGIC IDAHO;INC. - 1DU 073114 654 <br /> GRAM VMR ID 83624 <br /> Facility's Phone: (KIM 274-1516 <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 /> 1. UNIM,IAI STEARROSOLS,2.1 (COT S" 11296),ERG out DF OM P DWI DM 0031 <br /> o #128 <br /> 40007 DW 331 <br /> z X 2.RQ,UN1�,V*de,FlalnmaW .,n.o.s.,(onift 002 DM 00W P 331 00611 0001 <br /> pe-beb m didd dii 3,Pall,0011,ERG#128 <br /> 0007 !l154 U161 <br /> 3.MAIM,14Ie Ftta+eee,4.1,PG 11,ERG#133 001 DF 0*" P D001 <br /> I <br /> 4. UM104i.,Fre Edhhel; ?-2,E11G#q26 '�� CY 010010 P 181 <br /> 14.S ecial Handli g Instruction and Additional Information <br /> a t�Tl +SAE'+ PI -AFRI ,XS r WSW*V:CVTAWFRS 0(111 M MATH 00T-13P 111M STOM 0 WJIMA-FWw.mUt,LV-06 F <br /> faflRi. ,.llUlJt�,ID(31141,fVJil,f?61Ti,[ �;[ 14 3. WiPE°�TW1 t AME'5TM11 -Fkm-wAh;cYekt Top 4 1Wr*TM14 d VdEFtTM14 -FfRF <br /> E.�tT1NC�1►I°.;IiFI�_+�1Ml+�.rf NAI��(,ff4�;(T.14.19.f�'I19�1.N, <br /> ( /)0 ) 11 ( <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION:I hereby declare that the contents of this consignment are fully and accuralelydescdbed 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 /> Genera aJeWiD ferar's PrtnledfTyped Name Signature ' ' - monul Day Year <br /> .524uft`Y tA a/i..,'n�rx it" <br /> 18.Intemalfonal Shipments <br /> ❑Import to U.S. ❑Export from U.S. Part of entry/exit: <br /> Transporier signature(for exports only): Date leaving U.S-: <br /> W 17.TransporterAcknowledgmeht of Recelpi of Materiels <br /> Transporter 1 P*t dtTyped Name Signature, month Day Year <br /> 111 Oil ]b <br /> Tfansponer 2 Prfn4ad+Typed Name Sigitaiurts Month Day Yosr <br /> 10 1 <br /> 18.Discre nc:y <br /> 18a.Discrepancy Indication Space ❑Quantity ❑Type Rastdua ❑Partial RejectionJ <br /> ❑Full Re action <br /> Manllint Refempm Number: <br /> 18b.AltemMa Facility(or Generator) U.S.EPA ID Number <br /> J <br /> LL FacililysPhone: } <br /> W 183.Signature of Alternate Facility(or Generalor) Morith Day Year <br /> Q <br /> z <br /> 19.Hazardous Waste Rapori Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems]. <br /> LU H141 2. H141 3. H110 4. H132 <br /> 20.Destgnaled Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as in Item 18a <br /> PrintNaRt 5ignaiure r Mh f <br /> T <br /> EPA Farm 8700.22 Rev.3-05) Proviotrs editions are obsolete. DESIGNATED FACILITY TO GENERATOR <br />