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142 <br /> r <br /> Please ra-F. Form designed for uae an elks 12-pitch tYPewdter.) <br /> UNIFORM HAZAR0008 1,Genemmr ID Number ,� 2 Palo t M E p� Form Approved.OM No.2p50•p0 <br /> WASTE MANIFEST CRL00817 3590.. �, .MIAMIIt c na Nem or <br /> 5.086 eretor8 Name and III Addraaa /at )6 844140 NC I�J <br /> V S <br /> ARCH ARCD AM PN aenemmrssrmaddmss(ddBe gtthanM aingeddrees) <br /> 49f5 i S STATE HIGHWAY 99 <br /> STCICI{rG)N CA 95215 <br /> Generalora Phone: 209•-948-2439 <br /> °SYSTEMS, INC, U.E.EPAID, er <br /> 7.Tra TXR000050930 <br /> napanu 2 Company Name <br /> .S.EPAID umber <br /> 8.Deslgnaled Fac Naaeand SMAddreac US ECOLOt3Y IVEVADtd 1 DNumber <br /> 11 MILESG OF BEATTY HWY 9'.i � <br /> BEATTY , NV $91003 <br /> 800-239-3943 <br /> Facd ephona: NU'f330010000 <br /> ga. III U.S.DOT Desdipeon QndedNg proper ehyprr,a Name,Hazard Gas;Ip Numbe, o <br /> HM sed Parddng GrWP(Barry)) ,cwnama s <br /> 11.Total 12,Unit <br /> No. Type gaanGy WILA/sI 13.Waste Codas <br /> 1 NON RCRq HAZI WATER)WASTE L,IQU:r.DS <br /> s tUSED COIL AND WATER) DM P3 <br /> 2 d L10� <br /> 3. <br /> a. <br /> 14. pedal Handling lreWeUMa M(amaD;n SK SHIP4004I45585 54189213 10065483 <br /> 24 HIR <br /> ZET4S5lEKERASK PUT HRIDO RETAIN LICENSED BEQUNTCARRIERSS NECESSARY <br /> 15. GENERATOR'&OFFEROR'E^ERTIPICATION: T hereby tlegam mel Ina Contenm aF Bg9 galsignmenl are mayarm ea7aafely deecr@ed a6ow D Ina <br /> madwd and IaDdadlpterert(ed,and are In all reapeg9ln proper candleon fa henappn acwmlm b Y Proper ehlpptrg name,and are classified,packaged, <br /> Exponer.I mrtitythat me contents o1 this mns gmr anlwmfomr to the farms of ftaKachw EPAAcdgy{edgmentt at Conkers.�donar gawmmentel regNellWb.If expel shipment and I am the Primary <br /> I raniy that the waste minslondon stalamem domfled in 40 CFR 262.27(s)(If I am a large gean8ygenenatoq or(b)(BI am a small quarI generarn)is he. <br /> arorar Name <br /> lPrim w° -1—IA fv2 MWIn Day r <br /> Li v � Yead <br /> Tmnsporlery Importto U.S. ❑Exponfroar U.S. Pon of entrylash; <br /> only): Date leaylng U.S.: <br /> 17,TmnspoRxrAdwM4 dptlenraF R"pt ofMelenats <br /> w Trr 1 Pdn a SignaWre <br /> 0O Mmth Day Year <br /> N <br /> Q rens r2 nlcWryped arta <br /> Signature <br /> Month Day Year <br /> T19.Dlscrepar y <br /> 1801.Diampency wkwon Space ❑ Duantiy ❑Type ❑RseMue <br /> ❑PwBal Rejegl°n ❑FuB Rejactlon <br /> MPOWR encs NmnI <br /> 18D.Alternate fedhty(or Generator) U.S.EPA ID Number <br /> J_ <br /> V <br /> LL FKRI Phone: <br /> 8 i&.SignaWm lemate Facially(or enemlor) m Y r <br /> NM,, <br /> Report Merregamenr M6Bmd Codes M.,codes for ha tardws waste treatment dsposel•and necyq'ptg systema) <br /> .�! 2 Owner orpperemr Cenifioetbn of rerx+Ipl of hezardWl matsne/a co'rered by pre manifest except ae need in Item 18aansaMonth Day year <br /> r. ,D ev sedidons are obsolete. D fGNATED FACILITY TO GENEFfR <br />