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Please grint or tvOe <br /> 'XP <br />Form Approved. OMB No. 2050-0039 4 GENERATOR *' I UNIFORM HAZARDOUS <br />WASTE MANIFEST <br />1. Generator ID Number <br />C A D 9 8 1 0 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 />021642718 JJK <br />5. GevidtgsaxikAtgigfc§Address Generator's Site Address (II different than mailing address) _ <br />PG&E MCDONALD ISLAND COMPRESSOR STATION <br />P.O. BOX 7640 2121 ZUCKERMAN RD <br />SAN FRANCISCO CA 94120 STOCKTON CA 95206 <br />Generator's Phone: 8 0 0 7 6 1 - 6 0 0 0 I <br />C Transporter 1 Company Name U.S. EPA ID Number <br />PSC INDUSTRIAL OUTSOURCING, LP 1 CAROO 02 0 9 5 4 8 <br />7 Transporter 2 Company Name U.S. EPA ID Number <br />I <br />8 Desiccatedt <br /> <br />Ea4lly Name and Site Addrss US EPA ID Number <br />ECOLOGY NEVADA <br />HWY 95 11MI S OF BEATTY <br />BEATTY NV 89003 <br />Facility's Phone: 775 553-2203 I NVT330010000 <br />9a. 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Containers 11. Total 12. Unit 13. Waste Codes <br />HM and Packing Group (if any)) No. Type Quantity Wt Nol. <br />u <br />A <br />1. NON RCRA HAZARDOUS WA.STE, SOLID (OILY SOLIDS) 352 <br />0 0 1 CM ID Y <br />2 <br />3 <br />I <br />4 <br />14. Special Handling Instructions and.Additional information <br />JOB # 170-1.010-00 15-J110 1.1. <br />PROFILE # 07 0 19 7369-0 , <br />i 72— 2S-2-4 4 (1— JOB* <br />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, <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 minimization statement identified in 40 CFR 262.27(a) (if I am a large quantity generator) 01(b) (if I am a small qua enerator) is true. <br />Generator's/Offes Printed/Typed Name 0 -IA AtivI ,Li el t- .. rit.ve Signature A Month Day Year n:e <br />P.121e— in 1,..e cot A C.-k. -9/1.-- I 'el I Il i I 34 14 <br />...1 <br />I.— <br />g <br />16. International Shipments Impart to U.S. 0 Export from U.S Port of entry/exit: <br />Transporter signature (for exports only): Date leaving TRANSPORTER 17. Transporter Acknowledgment of Receipt of Materials <br />Transporter 1 Printed/Typed Name • Signature Month Day Year <br />_ <br />.AP-12111 1 <br />,,.... <br />a <br />Transporter 2 Print yped Name Signature Month Day Year <br />I I I I 4--- DESIGNATED FACILITY ----0- 18. Discrepancy <br />Discrepancy Indication Space Quantity Type Residue Partial Rejection 0 Full Rejection <br />Manifest Reference Number. <br />Alternate Facility (or Generator) U.S. EPA ID Number <br />Facility's Phone: I <br />18c, Signature of Alternate Facility (or Generator) Month Day Year <br />I I <br />19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) <br />\---\\---57._ 2. 3 4 <br />20. Designated Facility Owner or Operator: Certification of receipt of hazardous materials covered by the manifest except as ncted in Item 18a <br />Month Day Year Sigre?..(5_\„\_____" <br />K Zi N 12_0 <br />EPA Form 8700-22 (Rev. 12-17) Previous editions are obsolete. DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM