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IF IF I IF F � s FILL I IF ^ ! yPl�rse printgr type. Form Approved . MB No. 2050-0039 ' ` IjNIFORM HAZARDOUS 1 . Genera or ID Number 2 Page 1 of 3, Emergency Response Phone-. 4. Manifest Tracking Number p WASTE MANIFEST CAM* 014 JVA 4 1 G B �' Generatoes .Name and Mailing Address ' Generators Site Address (if differentfi� than mailing address) ,1, MILANO Ct7 INC 910 W. 0HARTEA WAY 848 W CHARTER WAY 9TOCKT�iN CA 95206 sfioGlcrt�N , CA f�5ioe ILL Generators Phor�g 944-M2 U.S. EPA ID Number 6 Transporter 1 Company Name;: AMERICM VALLEY WASTI' 011.; INC. CARbO02723M 7: Transporter 2 Company Name U . EPA ID Number ;x f r< .. STEWYCLE SPECIALtY`-WASTE 66LUTioW. INC MNS0001:10024 I IF IF 8. Designated�Pacilily Name:and Site Address tI:S. EPA ID Number I IF IF I FILL 21ST• GENTURY.:ENY1K0W9NTAL MOW OF N4='VADA,I.LG NVD9608135339 2005 N I LX*1 S DIt. EAST IF I FERNL0 NV 89408 s : Facility's Phone/7&57'&2 . . . ga. 9b U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Containers 11 . Total 12. Unit 13. Waste .Codes HM and.Packing Group (if any)), No. ' Type Quantity Wt.Nsol. 1 . . I IF FILL I IF IIII s, W k' 1101 W3077, HAMM".- S MANSTE SOLIEI, N.O.S , 9, RC�iil!, LEADS P D00 7 13008 ItHROMIUIUIF ":� g �. IF IF IF W IF 2. C9 iIF r 3 �. IF U a fIf :, +' I It ;� kN : IF 4. it IF IF . . r .. IF, IF IF t IF IF it BYet 14 Special Haddling Instructions and Additional Information . _ z�- . . - _ r _y;. _ _: IF IF PRbF� LE 183O8bT-00 ILLS Iif�ETALFSHAVINOS ' FFtC3Ml �t7 i • �"` EMERa,ENCYCbNt �IGI `rUsLENI IF F IF ' `� IF Ii IF F 15. GENERATOR'S/OF'FEROR'S CERTIFICATION: l hereby declare that the contents of this consignment are fully and accurately described hove 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''rjalional,govemmentai regulations. i f export shipment andel am the Primary IF Exporter I certify that the contents of this,consignment conform to the terms'of the attached EPAAcknowledgment of Consent.' I ILL. I. FI certify that the waste minimization statement identified in40 CFR, 262.27(x) (if I apt a large quantity generator),or (b) (if I am a small quantity generator) is true. Generators/Offerors Print1 .edffyped NameIF, Signature ? `r g° ` ;y ' Month Day Year FF AA 16. International Shipments. y , Import to U.S. . . 0 Export from. U.S. Port of entry/e>?rt ' Transporter signature (for exports only) . Date leaving US.: I IF t IF IF W 17, TranspoderAcknovAedgment of Receipt of Materials . �> . Transpo r P led .tr ped Name Signa ,�, ,.� Month Da " ` Year ' / IF e IF .0 raw ' ZfifififirtiF Tran o 2 P t lryp d Name ° } /[� a--Z Met? I . I rtf I I doth ear I IF 2bofirmfiI ?104 18. Discrepancy , be.+" , 18a. Discrepancy indication Space, 0 'Quantity PILL r, Residue j, j 0 Partial. Re ection 0 Full Re ectioh It * a ' a IF C I IF Manifest Refe a tuber: r , ' 18b. Alternate Facility (or Genelatar) _ - •- - haS tl [e . a, rte r1 U:S:EPA ID Number _. IF pp IF for , and Will, accept the wasteLF ruI Facility's Phone. j jn . !' ' . W 18c,,SignatureofAlternate Facility (or Generdtor) Month Day Year Z 0419azardous Waste,[ eport Managemgnt Method Codes (i.e. codes for hazardous waste treatment; disposal, and;recycling systems) PILL,. F � 2. 3. . 4 IF IF 20; Designated Facility Owner of Operator: Certification of receipEof hazardous materials covered by the manifest except as noted in Itgm 18aIF PIF Name. r IAIIFI +I Sr�nature ! Month Day Year XjF � 0-22 , . ev: : 2A7 Prevtous ;e itions a obsolete. ''�"" ERA Form4870 ( ) bWATO FACILITYTO GENERATOR : :