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1;')ax- /16r37 <br />Please Drint Or tvDe. Form Approved OMB No. 2050-0039 4 GENERATOR w UNIFORM HAZARDOUS <br />WASTE MANIFEST <br />1. Generator ID Number <br />C A D 9 8 1 8 8 8 3 4 4 <br />2. Page 1 of <br />1 <br />3, Emergency Response Phone <br />844-334-2468 <br />4. Manifest Tracking Number <br />021642720 JJK <br />GeggdgsaAriwd&Pilogtddress Gegiggisogit.68Rstirj nIt than mailing address! <br />EE ISLAND COMPR SSOR STATION <br />P.O. BOX 7640 2 i 21 ii) <br />SAN FRANCISCO CA 94120 STOCK:TON CA 85268 <br />Generators Phone. 8 0 0 7 6 .1 - 6 0 0 0 I ' <br />Transporter 1 Company Name U S EPA ID Number <br />PSC INDUSTRIAL OUTSOURCING, LP 1 CARO 0 0 2 8 9 54 8 <br />7 Transporter 2 Company Name US. EPA ID Number <br />I 8. U.S. U.S. EPA ID Number <br />HVVY 95 11MI S OF BEATTY <br />BEATTY NV 89003 <br />Faciiitys Phone 775 553223 1 NVT 3 3 0 0 1 0 0 0 0 <br />1.98 Llb Ll S DOT Description (including Proper Shipping Name. Hazard Class, ID Number, 10. Containers 11 Total 12. Unit 13 Waste Codes <br />jityr and Packing Group (if any)) No. Type Quantity Wt.Nol. . <br />ta 1- NON RCRA HAZARDOUS IAASTE, SOUD pity SOUDS) 352 <br />A 0 0 1 CM 1 E- v <br />2 <br />1 <br />3. <br />14 Special Handfinglnettuctions IncljAddilion.al Information _ <br />JOB # 11B -1910-U017-J1114/ <br />PROFILE 1$ 070197369-0 <br />JOB* <br />15. GENERATORS/OFFERORS 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 respects In proper condition for transport according to applicable international and national governmental regulations. If export shipment and I am the Primary <br />Exporter, I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. <br />I certify that the waste minimizafion 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. <br />Generators/Offerors Printed/Typed Name OW &am ei F. 0 t.. Signature Month Day Year <br />/ e----- 30 ,O <br />--I <br />3 <br />16 Intemationa hipments •P— E Expert from APIr Port of entry/exit: Import to U.S. <br />Transporter signature (la exports only): Date leaving U.S <br />C4 17 Transporter Acknowledgment of Receipt of Materials rRANSPORTE Transporter 1 Printed/Typed Name Signature Month Day Year <br />Z:T71^^— 1 .eurimetft— r1 I / 30 - # <br />Transporter 2 PrintediTyp.ed Name ture Month Day Year 14- DESIGNATED FACILITY ----0- 11 18 Discrepancy <br />8a. Discrepancy Indication Space LI Quantity LI Type III Residue LI Partial Rejection LI Full Rejection <br />Manifest Reference Number <br />18b Alternate Facility (or Generator) U.S. EPA ID Number <br />Facility's Phone: <br />18c. Signature of Alternate Facility (or Generator) Month Day Year <br />19. Hazardous Waste Report Management Method Codes (i.e codes for hazardous waste treatment, disposal, and recycling systems) <br />I LIVES 1 I I 111 I a <br />3. <br />20 De , at Facility ; net or operator Certification of receipt of hazardous materials covered by the manifest except as ncted in Item 18a <br />Pd plae. , .„e ik j\., 41111 Sign Month Day Year <br />MP _) <br />............. . . .......... n. . ..... • i ms, ...... ,rs A I - - Nil • nier-re,r t•%/n7C111 <br />EPA Form 8700-22 (Rev. 12-17j Previous editions are obsolete.