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Please print or type. 4 GENERATOR ). I UNIFORM HAZARDOUS <br />WASTE MANIFEST <br />1. Generator ID Number <br />(—.4 I flf1(1477Q1 7 <br />2. Page 1 of <br />1 <br />3. Emergency Response Phone <br />Pfil&-7F1C-772; <br />4. Manifest Tracking Number <br />014709873 FLE <br />Generators Name and Mailing Address Generators Site Address (if different than mailing address) <br />ROSS ISLAND SAND & GRAVEL CO. ROSS ISLAND SAND & GRAVEL CO. <br />6605 SE. LAKE ROAD 1003 HUMPHREYS ST. <br />GleLQ_BT1A__ND, OR 97222-2161 'STOCKTON, CA 95203 <br />'es ' 503 036 0911 Transporter 1 Company Name U.S. EPA ID Number <br />Advanced Chemical Transport Inc./DBA ACTemiro I CAR000070540 <br />7 Transporter 2 Company Name U.S. EPA ID Number <br />I <br />8. Desgnated Facility Name and Site Address U.S. EPA ID Number <br />US Ecolsiy Newada, Inc <br />PO Box 578,1-W95,11 Miles S Beatty NVT330010000 <br />Beatty, NV 89003 <br />Facility's Phone: 77rp.s52„07ne; I <br />ga. 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Containers 11. Total 12. Unit 13. Waste Codes HM and Packing Group (if any)) No. Type Quantity Wt.Nol. <br />1 Non-RCRA Hazardous Waste Solid (Absorbent booms clw c <br />oil) <br />m VINf2 <br />, <br />352' , <br />2 <br />3 <br />' <br />4 <br />Special Handling Instructions and Additional Information Project Number 278248 Document #: D337370 <br />1) 070300968-0 ROU- k )1 /4"- C ..N\ C._4-taN <br />0-oqu <br />GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name, ard 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 EPAAcknowledgment 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) (ill am a small quantity generator) is true. <br />Generators/Offerors Printed/Typed Name Signature Month Day Year <br />0,APAR... IVS.Q..7ifits- I 2/(//446 I V I I c)--lal <br />_I <br />r— <br />International Shipments Import to U.S. Export from U.S. Port of entry/exit: <br />Transporter signature (for exports only): Date leaving U.S.: <br />5 17. Transporter Acknowledgment of Receipt of Materials TRANSPORTE Transporter 1 Printed/Typed Name Signature Month Day Year <br />k ()`‘ , NkijA 1/4—I CAkkhr.t, V‘s.- I 0/1/ It 11-1 <br />Transporter 2 Printed/Typed Name Signature Month Day Year <br />I I I I -4- DESIGNATED FACILITY --0- ' 18. Discrepancy <br />Discrepancy Indication Space LI Quantity Type Residue Partial Rejection Full Rejection <br />Manifest Reference Number: <br />Alternate Facility (or Generator) U.S. EPA ID Number <br />Facility's Phone: I <br />Signature of Alternate Facility (or Generator) Month Day Year <br />I I <br />19. Hazrdous Waste Report Management Method Codes (Le., codes for hazardous waste treatrnent, disposal, and recycling systems) <br />1. <br />1 ?) rL <br />2. 3 4 <br />20. Desig ated acility Owner or Operator Certification of recei?14 hazardous materials covered by the manifest ekcept as n in Ile 18a \ <br />Printedayped Name F1 : <br />A AI <br />Signature Month D , Year <br />I 01_103 111 <br />Form Approved. OMB No. 2050-0039 <br />EPA Form 8700-22 (Rev. -17) Previous editions are 0 <br /> IGNATED FACILITY TO EPA's e-