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rn� _ Please print or type. Form Approved. OMB No. 2050-0039 i . Generator ID Number 2. Page 1 of 3. Emergency Response Phone 4. Manifest Tracking Number UNIFORM HAZARDOUS r' WASTE MANIFEST GAL 000288489 1 1 .888-785&7225 012280152 F L E 5. Generator's Name and Mailing Address Generators Site Address (if different than mailing address) Dragon ESP LTD 15700 McKinley Atienue sherii. hethea rnodernusa. corn Lathrop, CA 9M Generators Phone: 209-858-9125 6. Transporter 1 Company Name U.S. EPA ID Number Advanced Chernica) Transport incJDBA ACTENVIRO CAR00Z307D540 7. Transporter2 Company Name U.S. EPA ID Number 8. Designated Facility Name and Site Address U.S. EPA ID Number US Ecology Nerdda Inc NVT33W10000 PO Bex 5/8. Huw 95, 11 Miles S Beatty Beari NV 89003 Facility's Phone: 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.NoI. i .NA3077, Hazardous Waste Solids, N.O.S. (Barium) , 91 PGID � y P pp05 181 o X (Di W z A 0 . Hazardous waste, solid, III (CHROMILIM, DOD71 1701 1 181 0 X SILVER), 9 , PG131 3. /> I 4. 14. Special Handling Instructions and Additional Information tjCt Ntxnber 172958 Documglt # D207979 I ) 07012$301-15179 DRL�SS 23 ERGtkl71 ; 07012KWS-6900 6i I `2 15, GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that Ne contents of this consignment are fully and accurately described above by the proper shipping name, and are classified, packaged, marked and labeledlplacarded, and are in all respects in proper condition for transport according to applicable International and national governmental regulations. Ifexport shipment and I am the Primary Exporter, I certify that the contents of this consignment conform to theterms 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 quandi generator) or (6) (ifI am a small quantity generator) is We. Generators/Offeror's Pimed7yped Name Signature / /� � Month Day Year Ir it 16. International Shipments � ❑ Import to U.S. ❑ Export from U.S. Port of entrylexpit: K Transporter signature (for exports only): Date leaving U:J.. W 17. Transporter Acknowledgment of Receipt of Materials K Transporter 1 PintedTyped Name F� i Signature ' T Day Year oil � i ✓,bN Z Transporter 2 Printed/Typed Name Signature Month y Year 18. Discrepancy t8a. Discrepancy Indication Space ❑ Quantity ❑ Type ❑ Residue ❑ Partial Rejection ❑ Full Rejection Manifest Reference Number. 18b. Alternate Facility (or Generator) _ U.S. EPA ID Number i U Facility's Phone: W 18c. Signature of Alternate Facility (or Generator) Month Day Year Q z 19. Hazardous Waste Report Management Method Codes. (i.e., codes for hazardous waste treatment, disposal, and recycling systems) 0 1. � 2. � 3. 4. 20. Designated Facility Owner or Operator: Certification of receipt ofhazardous materials covered by the manifest except as noted i 1Be PrintedlTyped Name . Signature ,i ^� 1 Morlth Day Year J ('J LI EPA Form 8700-22 (Re . -17) Previous editions `re obiiflolete. DESIGNATED FACILITYTO GENERAT01 r ,