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Please print or lype.(Fami designed for use on elite.(12-plicll)ippewriter.) s Fotm,Approved.OMB No,2.050-0039 UNIFORM HAZARDOUS anerator ID Number 2.P"e^'o � a am est racket um air WASTE MANIFEST AL 000 287 469 2 Ulld 017 4 '7 716 JJ K 5. s N sad alli 9 d a d Gana�tn�s03E,(ef�l {ff�dlA@�t than maliing address,) 6 STOCKTON, CA 95203 Generator's Phone: (209)464-2922 R.Transporter 1 Company Name `, U.S.EPAID Number EQ INDUSTRIAL SERVICES MIK 435 642 742 7.Transporter 2 Compahy Name U.s:EPA ID Nuf or SN9TH SYSTINAS MED 966 382 133 8.Designated FadWRame and SIteAddress ECOLOGY, NC U.S.EPA ID Number HIGHWAY 95, 12 MILES SOUTH OF BEATTY NWT 330 010 vw BEATTY,NV 89003 Facility's Phone: (f 75) 553-2203 9a 9b.U.S-DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit HM and Packing Group(if any)) Ndr Type Quantity Wt.Nol. 13.Waste Codes IX 1. e Asmsok, FhmmmNe, 2.1 (DOT-SP 11206), 001 00002 P DWI 0035 D039 ERG 0128 D007113008 I 331 it SRO, UN+i1003, w FirfiNe ,n.0.5. ([1 001 0006/ P D001 00014-ID018 � P�t�b11�tl�y, 3, Pf311, RQ�1 U902 U154 � 331 3 ':N32114,V*09 Soft Cw1o>6*v Cwro*e Lhpft,n.0.s. 001 OF 00004 P Sod=Hy od"Mle, Scdlum Hyr'dwtfde),8, PG ff.FR©#154 D002 121 d 4. - NON-0OT,UNNERM VOSTE SATMRIES 001 ' DF 00008 P 181 14, el Hand ng Inst OlonsandAddl#fonal'Ir+f4rmattpn 1 STMaI iAKnWs-Flom 2.WESTM02L I Flammable Liquids 3.WES'FM08 f 8851C Liquids 4. WESTM19/Universal Will 8etteries (T:14.14.54772.11 15- GENERATOR'S10FFEROR'S CERTIFICATION: I hereby dedara Ihnt the'contianls of Chis consignment are full),and accurately described abbo by theiproper shlpping name,and are classlfled.packaged, 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 Pdmary Exporter,I Q rtify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent, I ceruly that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(ill am a small quantity generator)is true. Generator'slOfferor's Printed/Typed Name signature Year 117 �116,International Shiptnonfs ❑Import to U.S. ❑Export from U.S. Part of entry/exit: Tmnsporler signature(for exports only): Date Leaving U.S.: '17.Transpcder AcknoWledgmenl of Receipl of MatadaI4 6: TrafISP0ef i PrinotifTypad Narm�} Signature f', Manth Day Year IL t:t Typed Na:Yzaz Sign Month Day Year e� 1 -2, I': 18.Discrepancy. 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection El Full Rejection Manifest Reference Number: 18b,Alternate Facllify#or Generator) U.S.'PA ID Number J_ V u- Irmilty's.Phone: fM 18a. ignature of Iternate Facility(or Generator),, _- TMont5h7�ily Year Z Z N19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) LU c 1 2. H141 H141 3. H039 4. H141 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a ntedlTyped Name ��- signature mfirith Day Yaw EPA Form 9700-22(Rev-345) PreVI6liSedifionsare.obsoW. z DESIGNATED FACILITYTO GENERATON