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Please print or type.(Form designed for use on elite(12-pitch) ypewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4. <br /> .. .. Manifest Tracking Number <br /> WASTE MANIFEST 4901610 <br /> CAW4 V fe <br /> 5.Generators Name and Mailing Address Generators Site Address(if dtterent Than hunting address) <br /> Corn Proda1c-ta ih PAAx:iaaYa.crctdR Xtlr, iQ.^3, Ih+1UA$:t 18k3 OrP.p. Has 6139 wGaeStCcal, to *S1,06Ef'thackcrwT+. Ca 45206 <br /> Generators Phone: 0 ay <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> .XdViti ,:a:me8 Chaw.i0a.i. 'F1r4p u c ' s hIX <br /> ,,, <br /> 7.Transporter 2 Company Name U.S.EPA ID Numer <br /> nv <br /> 8.Designated�Facility Name and Site Address U.S.EPA 10 Number <br /> Ila F--&Il '"'7✓ Xepadm, 11w <br /> P.P-0box 8, fty 9$. Al mil" S. 7.faatkgp . <br /> Beatty, NV 111i <br /> Facility's Phone: 1Soi0-X94-;;5 4l:i <br /> ga 91b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit <br /> HM and Padding Group(t any)) 13.Waste Codes <br /> No. Type QuantityWtNol. <br /> Man EOC&:! RaaacdansaG®, Aaalad (iratl <br /> Shavings) jX a- P <br /> W <br /> Z 2. <br /> W <br /> t, <br /> 3. <br /> 4. <br /> 14.Special Handling instructions and Additional Information <br /> 1) 070138300-•1813; Cow 1" <br /> Projeelxt WaliCV02944- 01 <br /> `l J iL <br /> 15. GENERATOR'SIOFFEROR'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, <br /> 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 <br /> Exporter,I certify that the contents of this consignment conform to the tens of the attached EPAAcknoMedgment of Consent. <br /> 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 smait quantity generator)is true. <br /> enerators/Otemrs i-mmeatypeO Name igna. f. on ay ear <br /> 16.International Shipments <br /> Z ❑Import to U.S. ❑Export from U.S. ort of entry/exit: <br /> Transporter si nature for exports only): Date leavin U.S.: <br /> w 17.Transporter Acknowledgment of Rete' of Materials <br /> C Trenspo r 1 PrinWyped Name 1ignar i Monthay ear <br /> ff ,J ✓ .y� ,±Pt q IV IH <br /> R a 'po er2 Pnnte yped Name Signature Monch Day Year <br /> <r <br /> H <br /> I <br /> 18.Discrepancy <br /> laa.Discrepancy Indication Space QuantityEl <br /> Type Residue ❑Partial Rejection Full Rejection <br /> Manifest Reference Number: <br /> l8b.Alternate Fadlty(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> a <br /> LL adlit's Ph One: <br /> w 18c.Signa of Alternate Facility(or Generator) Month Day Year <br /> a <br /> z <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste Vestment disposal,and recydindiyslems) <br /> C 1 2. 3. 4. <br /> 20.Designated Facility Owner or Operator.Certification of receipt of hazardous materials covered by the manifest except as noted in Item 1 B <br /> Pdntedrryped Name signature Month Day Year <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. GENERATOR'S INITIAL COPY <br />