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UV6
<br /> i z Form Approved.ON Na.2050 QQ39
<br /> Please print or type.(Fomitdasigneo fp use:onelite(12=ptt )types ".) pp
<br /> UNIFORM HAZARDOUS i Gerferator It}Number 2.Page 1 of 3.Emergency Response Phone d.MannIffest Tracking Number
<br /> WASTE MANIFEST ,l;r � l ��r , 0,03434070
<br /> 5.Generatoes Name and Mail'ing Addy:. at ite ess(f different than mailing address}
<br /> PkMER Mmsq +- `
<br /> 7 110 S 1-04�@E ST;
<br /> Generator's Phone-=,Q
<br /> OCKT�a 2
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<br /> 5,Transporter 1 Company.ame U.S.EPA ID Number
<br /> 7 Transpoder3 Company Name U.S.EPA ID Number
<br /> j. ., . „isi..•.'e,.,.ws�..wi e�.._a..i.sw:+nra-s,.-�m,...w_e.,.:..,.�.,..v_w=+.+:+:vs+.�.,-....:,.;:..,..,-.::a..�..._..:,..x..,.
<br /> TYWASTP160111TIONS, INC.
<br /> signated Facility Name and'Site Address U.S.EPA ID Number
<br /> 21ST UNIT URY EWRONMENTAL MGMT OF NE-VADA,LL C N:1D�08 3.3H
<br /> 3005 NEWL.A[ OS DR.EAST
<br /> FERNLEY,W 8W0.9
<br /> Facility's Phone:
<br /> 9a. 917,U.S,DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 31.Total 12.Unit
<br /> HM and Packing Group(if any)) No. Type Quantity wt.lval. 13.Waste Codes
<br /> 0 ?( Ra,IJN1326 WASTE FLAMMABLE SOLIDS,ORBIC,N_0,8.,4.1, DM 01 fi41 P 13001 352
<br /> PG,POLYESTER A13GORBENTS WTH EHTAWX AND POLY?t+1-R � "f10
<br /> z 2.
<br /> X,..J. R0,t31419921 WASTE FELE LIQUIDS,N O.S.,3.PGI, d DM 220 G D001 F003 214
<br /> ACETONE,PANT
<br /> s.
<br /> 4.
<br /> 14.Special Handling Instructions and Additional.Information
<br /> 9811-PROFILE*728133-t11 ABSORBENT WPES WTH ACET0NE ERC*133
<br /> Ste-PRORLE#712968-01 PANT WASTE .&AC,ETCA* ERG*128
<br /> 15. GENERATOR'S10FFEROR'S CERTIFICATION: V 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 labeledlplacarded,and are in ail 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 mWmizaton statement identified in 40 OFR 262.27(a)(if I am a large quantity generator)or(b;Ainm a small quantity generator)is true.
<br /> GeneratoeslOffe is rintedlTypedNa , .-Si
<br /> 16.lntemation Ship en s
<br /> P- ❑Import to U.S. ❑Export from U.S. Port of antrylexit:
<br /> Transporter signature(far exports only): Date leaving U.S.:
<br /> y7;,T,tan der.AFl Por4ledgment pf Re,ceiptof'Materials e
<br /> ,T o rlPnntedlT @ .Name, Si Mores r-
<br /> er2�RnQW yPedNp a Signatur`e.; :, Month; Day Year.
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<br /> 18,Discrepancy
<br /> ISa.Discrepancy Indication Space ❑ Quantityi ❑T er a ,
<br /> yp f ❑Residua Partial Rejecfi0n El Full'Rejection
<br /> l / Manifest Reference Number: f CF M cf tveyoda
<br /> 18b.Alternate Facility(or Generator) U.S.EP D
<br /> has Thi appt��>�'ftte ' erMITS }
<br /> `_' {y�7 wrl� ccOprt fin.G waste
<br /> . 'FflS'.Illtyt5'PheneH.:.a`i� Hc,;.+�3'+.rr++r.;��. -'rMr +.+.wnpprviwnryrn++4..w',.; �,`yNm'•,a�i,a;w. ',��.., :.+avw•ri,w�r:.v.kxv��Mr�-.,,e�.r4�'..� `t .. "1".:v.
<br /> Uj. 19c SigrafUre of Alternate'Facility(or(3oriam r) MoffF Day Year
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<br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems)
<br /> LU '. 1-� 11 2. 3. .. 4.
<br /> }-} ..
<br /> 20.Designated Facility Owner or Operator.Certification of receipt cf hazardaus materials covered by the molfestpexceptas noted"n Item 1.8a
<br /> Printed/TypedName„ i' ;.r 5r afore
<br /> EPA Form 870Q 22(t 3 05) Previous editws are obsolete'
<br /> ' t. DE81ONkl'ED 1"ACLL_LTYTO OEIVERAT.4l�
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