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Please print or e. Form designed for use on elite(12-pitch)typewriter.) Form Approved. PBN.Y5O-0039 P h'P ( 9 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone4.Manifest Track' Number WASTE MANIFEST :'a;.r' ;_:`:<, i.;� r'.; 009 " 958 JJK 5.Generators Name and Mailing Address Generator's Site Address(if different than mailing address) !AIKJW-%Yr1 OW2 L00 V{:nIXt)t C/0 OTSC: ,;A&I c'kq,RO 1 FAtrri cnaRf,rif H-v 4 H Ct ¢Sox 1300 fArr*tnn CA R571S :�i1Ll�crrtrrec),l,ti a;iiSi.L Generator's Phone: 6 Transporter 1 Company Name U.S.EPA ID Number • . ::alt Ga-arartart; - 7.Transporter 2 Company Name U.S.EPA ID Number otu!izatatl rViCasot Fomnit- Lf' 8.Designated Facility Name and SlteAddress U.S.EPA ID Number 21 st Gar tury Emronmeental fUlarttil fl;mwit of 1096 East Newtandg Urr%;e F emfey,NV 86WJ8 Facility's Phone: •; ga 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit HM and Packing Group(if any)) No. Type Quantity Wt.Nol. 13.Waste Codes 1. � t.Vf013.Waste Butane.d.t.RS,7(DUU1j J a w z 2. LU 0 3 4. 14.Special Handling Instructions and Additional Information :A':m6 in ut aer,"- 15 -Ekk:kOek In Cai)-Weaf xWOpnate personal protective eqt iMerrt when handing "( i5) .lotW 5775 Cklaf11111 2015-01-007 15. GENERATOR'S/OFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, 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 Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a small quantity generator)is true. Generatdr's/CNferor's PrintedlTyped Name, Signature Month Day Year .j 16.International Shipments i— ❑Import to U.S. ❑Export from U.S. Port of entry/exit: _ Transporter signature(for exports only): Date leaving U.S.: w17,Transporter Acknowledgment of Receipt of Materials I-- le Transporter 1 Printed/Typed Name Signature O Month Day Year a Cl) Transporter 2 Printed/Typed Name Signature a Month Day Year t- 18.Discrepancy 18a.Discrepancy Indication Space ❑ QuantityI ❑Full Rejection ❑Type Residue ❑Partial Rejection Manifest Reference Number: 181b.Alternate Facility(or Generator) U.S.EPA ID Number J U Facility's Phone: w 18c.Signature of Alternate Facility(or Generator) Month Day Year Q Z as 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) LLI O 1 2, 3. 4. 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Printed/Typed Name Signature Month Day Year EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. GENERATOR'S INITIAL COPY