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i• <br /> i Please print or type (Form designed for use on elite(12-pitch)typewriter.) Form Approved,OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1,Generator ID Number . •r •r•� 2 Pagg 1 of -766 <br /> .M�ijfe Tr ki g r,J� <br /> WASTE MANIFEST V '#86 F <br /> 5,Generators Name and Mailing Address Generators Site Address(if different than mailing address) <br /> RAIL 'i�.RVIC-IFS <br /> I 6540 AUSTIN RD <br /> 5,1171 1,C{!(:rel co 9921' <br /> Generators Phone: 9?09_,.i}E°41 l <br /> Ie U.S.EPA ID Number <br /> o a <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address lis FrOtAX3Y U.S.EPA ID Number <br /> S l MILES S OF K'AlTY H4Y <br /> j OF-A17Y NV 8900:3 NV <br /> Facility's Phone: <br /> ga 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10,Containers 11.Total 12.Unit 13.Wpste Codes <br /> HM and Packing Group(d any)) No. Type Quantity Wt.Nol. <br /> j t DIM- <br /> 0 <br /> IM � . •�'�'c".: <br /> a r, <br /> 2 <br /> LIJ . IVINU (� RP i")r170Rl.'t,i � <br /> WASTE Gia.I fJ ;� <br /> ( 4 L. <br /> a. <br /> 4. <br /> 14.Special Handling Instructions and Additional Information f�+�rflt'' -1�3 tifQ4t�Ll,'`; r Li C <br /> f'4 ).'h , Mf=PC:r 'NCY #l---Wlb--4G8-17'60 i fat EFY—KlF:t=h <br /> SK P1,i' f 7 ? TO RETAIN L TEEMED ILLIBSEQUENTCARk iERSf ISNECESSARY <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately desaibed above by the proper shipping name,and are classified,packaged, <br /> marked and labeled/placarded,and are in all respects in pibper 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 terms of the attached EPA Acknowledgment of Consent. , <br /> I certify that the waste minimization stateme4 identified in 40 CFR 262.27(a)(if m a large quantity generator)or(b)(if I am a small quantl generator)is true. <br /> s y aSignature <br /> t gnaureeneratoes eroron May earA <br /> 1 <br /> J 16.International Ship is <br /> Importto U. ❑Export from U.S. Port of entry/exit <br /> Transporter signature for exports ot. Date leaving U.S.: <br /> W17.Transporter Acknowledgment of Receipt of Materials <br /> l'— Transporter 1 Prinled/Typed Name,- / Signature Monthay Year <br /> ZTransporter P' c'rN, Monthay ear <br /> a <br /> 18.Discrepancy <br /> 1 Ba.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> Q <br /> LL Facility's Phone: <br /> w 18c.Signature of Altemate Facility(or Generator) Month Day Year <br /> ZZ <br /> C9 <br /> H 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 0 1. 2. F <br /> 4. <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 1 Ba <br /> Printedlryped Name Signature Month Day Year <br /> EPAFRrt718 7 Q?�2�(ng -0��P�eyiwj�}d r�s�. �op�s e� rf.�1,4 GENERATOR'S INITUILCOPY <br />