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<br />Please print,or ly `e. Form ApptoVti�, OMe No. 2060.0039
<br />UNIFORM HAZARDOUS 1. Generator ID Number 2. Page i of 3. Emergency Response Phone 4. Man fe Tr c umcber
<br />CAL 0 0 0 0 4 5 9 2 2 1 ' 92+1-8300 Q� ��O 7 7 5 FLE:
<br />WASTE MANIFEST (800} U
<br />5 Gen . � idi's nmd.and flrig;Addrdss a 4 sl Add(dUs (i Qd a. l Ihel1'meuipg rese)
<br />{2u�`�:��op Inc. �u��e ��op a���ets, �nc. #lZt4
<br />,
<br />Mar)t�ts,
<br />4567 Ente>:prise Sheet 505 N. Meiin St.
<br />H'rement, CA 94531 Menteaa, CA 9b3S6
<br />Ganeralor'sPhone: (810) 4i6^2282
<br />Oi Transporler.t: comJianYN�mo U,s: EPA ID.Number
<br />BELSHIRE �AitO 0 0,1 B 3 9 13
<br />7, Trenspotfer2Campany ame U,S.:EPAID Umher
<br />S.:De"sigiteted F.aclGty;Noina and Sitti'g�dress U,$. EPA ID Number
<br />'S
<br />U . Ecoldgy Nevada Operations 9 V T 3 3 0 010 0 0 0
<br />g�ghway 95, 1 m lea S. of Beatty
<br />Beatty, NV 9003
<br />FOcflit.aplf'alie;?r (77S) 553-2203
<br />9a.
<br />9b. U,S, DOT Dsscdpllon (Irxduding ProperShlpping Nems, Hazard Class, ID Number,
<br />10. Conlelnere
<br />11, Total
<br />12. Unit
<br />13, Waste Codes
<br />HM
<br />and PackiRq Group (U any))
<br />No,
<br />Typa
<br />QuenHty
<br />WI.NoI,
<br />1• IVDn—RCRiI iiasrnrdoua WARrtiC, Solid (ERG #171)
<br />P
<br />352
<br />AD018
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<br />(Rages, nbeorbent, s debrfss impacted.with
<br />pettroleum hyd'rpa�rbe.ne}
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<br />w
<br />2.
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<br />3,
<br />4;
<br />1 .Sptidat an�Ung(nsUud(ansapdAtldlitonallnforinaitori 4JEbR ,ALL 1►PPROPRiA.TE HL,+�I � � (�'7 � � tl� '
<br />Generator is x ACRb V9Q6 ass defined in PER80NbL FAOTECTIVE Qt]TIC:lR`OP CCN• 658P37
<br />40 CFR 260.10, nO1B aodn r�preeenbs CLOTHING,
<br />waabt that is R>CR�. identified bub not PROFILE # 07021�I257-0 !x
<br />ACM tcegulated. .
<br />16. OLNERATOR'S10FFEROR'SCERTIFICATION:.I herebydedere Uta! the conlente of UUs consignment are fully and accurately dasut@ad flh'ovb.by tiro propel shtpiring Warne, etd aro dassibed; packa0ed,
<br />marked andlabeladfplecarded, end are m all reepecla In proper condlllon for transport accordirg to applicable Inlemaibnafand national g0.v'eiiti»etjlnl reflulfllions; II e8pod ahipfipgl e'nd i am lhd Primary
<br />Exporter, (certify Iltat fha contents o[ ihls conslgnmeni conform to the terms of the eHeched EPAAckrtowledgmenl cl Consent,
<br />I ceriity That the waste minimtralbn alatomenl IdenUfled in 40 CFR 282,21(a} (If I am:a large quanllty.U6 (h) (itl:ont a small quentltygen or) Is true.
<br />(3en4mtoi'sf01(eror's f ritiied►ty�tid Name isnafurd. Mnnlh DA _ Year
<br />� N
<br />s� w,�DE� � �h �-
<br />18, INsrnaib0al'$ pmpn4c � Import to U,S. ❑Export from U,S, Port of entrylexih •,
<br />Treijspdder slgttalute (lo�.expoda Doty); Dale loajving U:S;:.
<br />17, 1tansporterAcknowledgmentof Recelptof Materials
<br />R
<br />Trdtrspotlofl Pr(nladlTyped Name �: Ignalure MaiUt Day :ear
<br />a
<br />�•
<br />"1 ''; C� •J (�
<br />Tregsporler2 Prbtled/Typod Namfl' signature Mdnth pay Year
<br />'
<br />18, Discrepancy
<br />��--��yy
<br />10a, Discrepancy IndlpUon Space �❑ quenllty ❑Type I.1 Residue 0 Partial ReJecUon ❑ Fuli ReJeotlon
<br />Mani(osl Rolerdnce Numbsn.
<br />18b.AllorgaigFadllty,(otGenerator) U,S.EPAIDNuntbor
<br />V
<br />►4+-
<br />F'sdlpy's Phone:
<br />w
<br />tk. Sighaiura ntq IomAl9 Fadlliy'(or Generator) . Moniti. Day Year
<br />4z
<br />�
<br />Mftpa.8onton! Method Cafes (i.e„ codes for hazardous waste treatment, disposal, and r6typlli�l systems)
<br />19.
<br />Hazdrdqus Waste Reparl
<br />4.
<br />p
<br />i r
<br />2
<br />3;
<br />20, beslgnaled Facli ly Owner orOperalor: CorUflcaUon of receipt of hazardous meterlals covered by the manifest exceptaa nded in Item 18a
<br />RrinledrTyP amo S rdgalure Day oar
<br />Foim 8700.22 (Rev, 12:91} ;Ptovlour; ediilons are obsolete. DESIGNATED FACILITY TO EPA's e�MANIFEST SYSTEM
<br />EPA
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