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Please print or type. ' fr' ILi <br /> Form Approved. OMB No. 2050-00: <br /> UNIFORM HAZARDOUS. 1 . Generator 10 Number - 2. Page 1 of 3. Emergency Response Phone 4. ManifestTrackingNumber f C <br /> WASTE MANIFEST CAL000286489 1. 'I _$�7$J-7�J 012285113 FLC <br /> 5. Generators Name and Mailing Address r Generators Site Abdress (if different than mailing' address) , <br /> Draggoon ESP LTD <br /> 15700 <br /> McKinley Aaenue Sherri. hethea@modernusa. cor <br /> LathfOp 3.1 <br /> Generators PhoneCA: 208-8S9506-9y Z3 <br /> 6. 1 mnspprter l Cafnpany Name U.S. EPA ID Number <br /> Advanced'Chemlcai Transport Inc./DBA A=NVIRO CAR00007054o ' <br /> 7. Transporter 2 Com an me U.S. EPA ID Number <br /> S. Designated Facility Name and Site Address <br /> US Ecology Nevada, Inc U.S. AID Number <br /> NVT330010000 <br /> POBOX 578 x, 11 Miles SBeatty - <br /> Beatty; NV { <br /> Facility's Phone: /755532203 <br /> ga 9b. U"S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Containers 11. Total 12. Unit <br /> HM and Packing Group ('rf any)) No. Type Quantity WuVol. 13. Waste Codes <br /> 1 NA3077, Hazardous waste, solid, n o,s. (CHROMI[SM, <br /> aX SILVER), 9 , PG➢I DM 0 � P D007 0011 18' <br /> a o I <br /> W ��// <br /> Z 2. <br /> W I <br /> 3. <br /> I <br /> 4 <br /> a. spe ial Handling Instructions andAadmpnal Inro matlon Project Imre 1712011 pacumcnT # CV06936 <br /> 91f11 <br /> 11 ERG71 : 07012831X38900 DRi} uol - e la ( 10 Y S O <br /> 15, GENERATOR'SIOFFEROR'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 /> marked and labeled/placarded, and are In all respeca in proper condition for transport according to applicable international and national governmental regulations. If export shipment and I am the Primary <br /> Exporter, I oedlfy 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 /> Generators/Offerors PrintediTyped Name ( Signature // Mop�N{y 'Dia] Year <br /> ., alt . ' I tf ,� 6. � C4 J i�J" _ L/ / <br /> 16. International Shipments r '-� <br /> 1:1 import to U.S. LJ Export from U.S. Port oferdrylexi . <br /> ? Transporter signature (for exports only): Date leaving U.S.: - - ' <br /> W 17. TransporterAcknowledgmenlof Receiptof Matedals _ <br /> T�`rrrsp�orter 1 Pr//inted/i etl N e signalur tr. Mon Day Year <br /> a - <br /> Transporter Printed yped y - Signature _ rDYear <br /> 18. Discrepancy <br /> J <br /> 18a. Discrepancy Indication Space ❑ quant <br /> dY ❑ Type Residue ❑ Partial Rejection ❑ Full Rejection <br /> Manifest Reference Number: <br /> 186. Alternate Facility (or Generator) U.S. EPA ID Number <br /> J <br /> U <br /> LL <br /> Facility's Phane: <br /> w 18c. Signature ofAlta mate Facility (or Generator) - Month Day Year <br /> a <br /> Z <br /> 19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) <br /> O 1 . 1 2. 3. 4. <br /> 20. Designated Facility Owner or Operator: Certification of receipt of hazardous materials covered by the manifest except noted Item its . <br /> PnntedlTyped Name Signature th Day Year <br /> EPA Form 8700-22 (Rev. 12-17) Previous editions are obsolete. DESIGNATED FACILITYTO GENERATOF <br />