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Ple€ rintor iy e.(Form designed far use on elite(12 pitch)typewnter.) Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Fgggc) cafine 14.Manifest Tracking Number WASTE MANIFEST CAL 000 287 469 1 l 11 017477669 JJ K 5.A or's N jagdgpjjJp9l�d�[p�q Ganiloi�51�(�Se�(it�i'�f�rgpt than mailing address) 5011 WESSTTRIDiGjJE RF;UV� Itj ItL A}jE WATSONVILLE, C 950 6 STOCKTON, CA 95203 Generator's Phone: (209)464-2922 6.7ransportar 1 CampEmy Nam. U.S.EPA ID Nmter EQ INDUSTRIAL SERVICES MIK 435 642 742 7.Transriarter 2 Company*MD U.S.EPA ID Number 8.Designated Facility Name and Site Address US ECOLOGY IDAHO,INC. U.S.EPA ID Number 20400 LEMLEY ROAD IDD 073114 654 GRAND VIEW, ID 83624 Facility's Phone: (800)274-1516 9a, 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes HM and Packing Group(if any)) No. Type Quantity Wt.Nol. X 1-UN1013,Carbon Dioxide, 2.2, ERG#120 001 CY 00001 P 181 0 ZX 2-RQ, UN0403,Waste Flares, 1.413, PGII, ERG*114 001 DF 00002 P D001 D003 D005 C5 141 X 3.UN0312,Waste Cartridges, Signal, 1.4G, PG 11, ERG*114 001 DF 00005 P D001 D003 D005 141 X 4•UN3108,Waste Organic peroxide type E, solid (DibenzcrA 001 DF 00004 P D001 271 peroxide (paste), «52%). 5.2, PG II, ERG#145 14.S ecial Handling Instructions and Additional Information 1.I�YESTMI3/CO2 Cylinders 2.WESTM22/Aerial Flares 3.WESTM231 Signal/Smoke Flares 4.WESTM371 Benzoyl Peroxide Based Loosepack Hardener]T:14.14.54772.1] 15. GENERATOR'S/OFFEROR'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, 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 Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. 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 quallllly generator)is true. Gene' torslOfomr'5 Printed ped Name ^ Signt+ Month 1 o 1 Year ISL y70Ok 16.International Shipments ❑Import to U.S. Export from U.S. Port of ent lexit: _ Z Transporter signature(for exports only): Date leaving U.S.: W 17.Transporter Acknowledgment of Receipt of Materials Transp r 1 Prinledlryped. Signature Month Day Year a 11 117 117 Z TrkslpoNr 2 P&Tee-ypad Name Signa re y Month Day Year 18.Dlscrapan 18a.Discrepancy Indication Space ❑ Quantity ❑Typej j ❑Residue Partial Rejection Full Rejection Manliest Reference Number: 181b.Alternate Factillty(or Generator) U.S.EPA ID Number J_ V LL Facility's Phone: W 18c.Signature of Alternate Facility(or Generator) Month Day Year Q Z N19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) LU 1 H132 2 H132 3 H132 4 H132 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 1 Be , Pdn yp d Name � S 16 ,e '�Month �Y �� ■ /Gf/�' 11 ' EPA Farm 8700.22(Rev.3-05) Provlous editions are obsolete. ESiGNATED FACILITY TO DESTINATION STATE (IF REQUIRED)