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ease print or type ro•ni Aporoa:kl 11103 1tc <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2 Page 1 of 3.Errwrgency Response Phone 4 Manifest Tracking Number <br /> WASTE MANIFEST C 11 A 0 0 0 2 Z 7 9 2 6 1 (800) 929-9300 1015011377 FLE <br /> 5 Generator's Name and Mailing Address Generator's Site Address(:f different than m.-r4r, add(e si <br /> Costco Wholesale Corporation Costco Wholesale - STOCKTON - 0038 <br /> PO Box 80988 1616 East Hammer Lane <br /> Rancho Santa Margarita, CA 92688 Stockton, CA 95210 <br /> Generator's Phone (94 9) 460-52001 <br /> 6.Transportar t Company Name US EPA ID'lumte, <br /> BELSHIRE CAA 0 0 0 1 8 3 91 3 <br /> ? Transporter 2 Company Name US FPA rD NnmCr•r <br /> 8.Designated Facirity Name and Site Address C S.cPA D Ntn,w <br /> US Eco1Qgy Ne da Oper tions NV T 3 3 0 0 1 0 0 0 0 <br /> Highway 95, oil as S. o Beatty <br /> Beatty, NV 0 (775) 553-2203 <br /> =ac lity's Phone: <br /> ga 9b.U.S DOT Descnpt,on(including Proper Shipping Name,Hazard Gass,ID Number, 1C Containers 11 To.al 12.Unit <br /> HM and Packing Group(if any)) Vo Type Quantity WI.rVo' 13 Waste Codes <br /> 1 UN3175, Waste Solids Containing Flammable P 352 D0I8 <br /> o X Liquid, n.o.s., 4.1, PG II (Contains <br /> Gasoline) IJOG I <br /> W <br /> Z <br /> W <br /> 3 <br /> 4 <br /> i <br /> i <br /> 14SpecialHandlinglni"ionnandAdditional Information MEAR ALL APPROPRIATE <br /> ZM#: 133 PROTECTIVE CLOTAIPG BE S I : 3 2 3131 y Alm <br /> Absorbent, Filters, Debris Contaminated COSTCO CCN: 665883 WTUT <br /> with Gasoline <br /> PROFILE # 07-012-8301-1785 <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fuly and accurately descr bed above by the proper snipping•ane and are classded,pac4a„cd. <br /> marked and labeledlplacarded.and are in all respects in proper condition for transport according to applicable irtemationalare national governmental regulations If export shipmen!and I am the Primary <br /> Exporter.I certify,ttral the contens of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. <br /> 1 certi'y that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)Off am a sPouantity generator)is Pue <br /> Generator's'Offerors PrimedlTyped Name Signature Mont'! Dry Year <br /> Larry Hoothart of BESI on behalf of generator Zo I LP Z <br /> J 16 IntemaWnal SMpmenls L__!I� <br /> � Import x L.S Export from U.S. Port of ertrylexit <br /> ? Transparle,signature ffor a,ports only) Date le;v ng U S <br /> W 17 T,ansporter Ackrowledgment or Receipt of Materials <br /> LU <br /> I-- TP`•rtedlTyped tl,frnr Signature \ I.r,;nth Dn, u <br /> ZC <br /> Z Transporter 2 ninted/Typed Noma Signature f,!�•,m �ay <br /> t•- <br /> 18.Discrepancy <br /> 18a Discrepancy Indication SpaceEl �I 1 <br /> Ouatltity Type LJ Residue Partial Rejection C.�FUII Rejek;lion <br /> Manifest Reference Number. <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> v <br /> LL Facility's Phone. <br /> W 18c Signature of Alternate Facility(or Generator) Month Day Year <br /> Q <br /> Z <br /> N19.Hazardous Waste Report Management Method Codes(i.e..codes for hazardous waste treatment,disposal,arta recycling systems) <br /> 0 1 <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by Ine manifest except as ncted in Item 18a <br /> PnntedaTyp- Nam% / Sionaturd fdonth D y rc:u <br /> f O <br /> EPA Form 8700 22 Rev 12- 7) Previcus e s are obsolete. DESIGNATED FACILITY TO EPA's e•MANIFE5T$`/' ' <br /> 0038/2399724 <br />