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QCT;T�1342009 12:08P FROM: � TQ: 12094583433 P.4 <br /> Please print or type.(Form designed for use on elite(12-pitch)typewriter.)) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1I.GanerajorIONumber 2.Page i of 3,Emergency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST L., 4 O 1 5 0 9 M" SKS <br /> 5.Generator`s Name and Melling Address Generators 51te Address i different than malllng address) <br /> VILL:A-'E 44C::T MAR11-4A <br /> ,T1:4'"F'7JIt rA '.?5:19 <br /> Ganerators Phone: r'r�_'~`"1 .k 5.1 <br /> 6.Transporter t Compan Name U.S.EPA ID Number <br /> .,A.; = , #,kIN .,Y','T .NiS_ 1.N1 TXU0000'-09J0 <br /> 7.Transporter 2 Company Nama U.S.EPA ID Number <br /> B.Designated Facility Name and Site Address14 U.S.EPA ID Number <br /> U F rj�rri; ! <br /> NEVADA 01 V05 <br /> 11 Pi I.1l.'i OF BEATTY HWY i <br /> UFATTV NV 81400.3 <br /> NVT330010000 <br /> Fa66 sPhene: <br /> .f <br /> ga 9b,U,$.DOT Descrtptton(including ProparShipping Name,Hazard Class.M Number, 10.Containers 11.Total 12.Untl 13.waste Codes <br /> HM and Paddng Group(V any)) No, Type Quantity WLNot. <br /> a A#' k6luk tiA'LAlt -((,1:. 1:= .`1'l t 1 4it.c t.f3' DX it <br /> � , .::�:::�#lfrlrrET 7•iti;� r;?�[. ;I �;..� � <br /> i 2 <br /> w <br /> cn <br /> r <br /> 3. <br /> I <br /> a. <br /> 14.Special Handl'urg Instructions andAddigorral Information <br /> r7S5frI8 r <br /> ksC►i12;�: <br /> i <br /> a <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents Df this consignment are fully and w arately described above by the proper shipping name,and are classified,packaged, <br /> marked and labeladlplacarded,and are In all respects In properconditlon for transport acoording to eppilcablo International and national governmental ragutatfoas,If export ahipmant and I em the Primary <br /> Exporter,I certify that the contents of Nis consignment conform to the terms of the attached EPAAWutawledgment of Consent. <br /> I wilily that the waste minimization stalemem Identified In 40 CFR 262,27(s)(f I am a large quantity generator)or(b)(fit am a small quantity gmerator)Is Irua. <br /> GenaratoeslOfferor'a PrkrtWffyped Nama Signature Month Day Year <br /> k 16.international Shipments 13Impofl to U.S. ❑Expert tram U.S. Port of entrylexlt: <br /> t Transporter signature,(for exports only): Data leaving U.S.: <br /> W 11,TransponerAcknoWedgmentofReceiplafMaterials <br /> E Transporter 1.printedffyped Name Signature ` Month Day Year <br /> Transporter 7 PrtntedllypedNama Sigrlstute %- Month Day Year <br /> 18.Discrepancy <br /> 18a,Discrepancy Wiiradon Spate 0 Quantity ❑Type ❑Resldus ❑Perlia{Rejection ❑Fuir Rejection ) <br /> C <br /> Manifest Reference Number: <br /> 16b.Alternate Willy(or Generator) U.S,EPA ID Number <br /> � E <br /> 14 Fadlity's Phone: <br /> W 18c.Signature of Altemate Facility(or Generator) Month Day Year <br /> 19.rtazaMous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> LUo 1. 2 T. <br /> 4• <br /> 20.!!! <br /> ty Owner or Operator.Certifltalion of recelpt of hazardous materials covered by the manifest except as noted In Item 18a <br /> - Signature on ay Year <br /> EPA Form 8700.22(Rev.3-05) Previous editions are obsolete. GENERATOR'S INITIAL COPY <br />