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Ft1m7Y""�• .dig No_2050-0035 <br /> Pie ase pain ectype.(Point o ned for use on elite(12-pitch)typewTitec) <br /> t^Generator ID Number 2.Page 1 of 3.Emerge <br /> Response Phone 4.Man Mest Tracking NumQber p� �/ <br /> EUNIFORMA7ARDOUSClaw USA 2uANIFESTNameand MaiBng Atldross. CAFPENT�R CO <br /> o s ;SARLA'N. Box g7Ga LA'FfiR6B. CA 9533U <br /> i Company Name <br /> I , UNSVAR USA ING, U.S.EPA ID NumWr <br /> I.Transporter 2 Company Name <br /> 2+ a <br /> OtI'GL L1NSi & S3L{7yA7GNT tw,Fj' us EPAONumost <br /> M1 <br /> 8.Designated Fadiny Name acrd Sne Atldresq <br /> ITS BCOL(IsY BEATTY <br /> >•':r BOX 578 <br /> ar"Y 9a (2I A43. S G*f" BEA'J"TY) t BEATTY, NV 090D3-057 #Type <br /> m g :a C, 11 1 0 f' R <br /> Factual'a Phone' <br /> So 9b.U.S.DOT Desaiplion(iududing Proper Shipping Name,Hazard Class,ID Number, 12,Unit 13,Waste Codes <br /> HM and Packing Group{carry)) Wt.Nd. <br /> 1.N027—k H.A EiA`t:AP C1V iiP 'Wir.3TE.r ${•LZu TOIL ANC+ ASSORdSNS2. Nt}N—Rut;P.A HAZARDOUS WASTE, 5,1QUIT1(SAO>LNUND 72541 <br /> J <br /> 3. Nl:)N—RCka' HA2A.RDOi7S WAT-S, rm— <br /> flANACTIstr OI1SOCYA14A287 <br /> i. <br /> 4. —RCRA HAZARDOUS WASTE, La.Q1F11? t (` <br /> 14.Spada]Herding Instructions and Additional Information <br /> .7. J7022830E-1507 0?U13t870- 5S2,a Il Ft n3UU--7990 4. 0701'i570-11'118 <br /> iPLACARDS PR(WrDED BY Al aFRISHIEPER YE9 DR! vM :iICNATURE <br /> rtzr. ER CALLER MUST ZilEiNT'Y.E'Y UNIVAR TSA s TEGISTRAtd`P (CU <br /> 15. GENERATOR'SIOFFEROR'SCERTIFICATION:I hereby cedars that the contents of the consignment are tufty and accaratalydesolbed above by he proper sNppklg name,and are desidded,padaged, <br /> marked and abekNplacarded.and are in all respects in proper condition for transport encoding to applicable international and national governmental regulations.It export Shemin t and I am he Primary <br /> Exporter.I canfy that me contents of rhls consignment conform to he terms of the attached EPA AcknoWedganrit of Consent <br /> I catty het the waste ronimawtoh statement identified in 40 CFR 262.27(a)Cf I am a large quanbty generator)or(b)(81 am a small quan8y generate)is too. <br /> Generatoesi 9eroes Prudeedfly N.M. Suyreture {/l� p° Nona {Dex Year <br /> L C h a Y^ (a f 1 Lp 1 7 <br /> 16.international Shipments <br /> ❑Import to U.S. LJ Export from LLS, %dotentrylexiP. .....__ __ ......................_ <br /> 2Date leavlrg U.S.: <br /> Tmnsponer sgreture ifo exports orgy): <br /> rM <br /> 17.Tmnspo Ackmavledgmenlof Pe iptofMatedals SigneMonro Day YewO Transryrler 1 PdmeoTyped Name mre <br /> q `t <br /> a ASiEP 1 f7B <br /> 2 TrenspMer2 Prmle,dR/yped sme.,�.-- SgnaWre �.-- .,._+ Month Day Year <br /> 'CIF7, lo 71 <br /> F <br /> ♦ 18.Discrepancy — <br /> 18a.Dnorepancy Indication Space El puantlty ❑Type tJ Residue ❑Partial Rejedion ❑Fuil Rejection <br /> Meanest Reference Number <br /> 18b.Alternate Facicy(or Generator) U.S.EPA IO Nominee, <br /> :31 <br /> ca <br /> s4i Facilityrs Phone. <br /> w '8c.Sgnstme of AiTamate fadOty(or Genoredor, Month Day Year <br /> Q ` <br /> z <br /> � 19.Nazar s Waste Repan Management Method Codas(i.e.,codes for hazardous waste Treatment,disposal,and rocyeing systems) <br /> G1. ...7� 2. •i._.. 3. t --'52 <br /> 20.Designated Fadtty Owner or Operator.Dedication of rece pt of hazardoos materials covered by he manifes,except as road in Item 188 <br /> VrM <br /> ( } } Signature g ( r D <br /> 1 tr, <br /> EPA Form 8700.22(Rev.3-05) Previous ed0ons aha obsomm. DESIGNAT D FACILITY TO GENERATOR <br />