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Please print or type.(Form designed for use.on elite(12-pitch)typewriter,) Form Approved.OMB No.2050-0039 :1 kr� t14.Manifest Tracking Number UNIFORM HAZARDOUS Generator ID Number 2,Page I of 3,Emergency Response Phrig:one WASTE MANIFEST 190 GB 0J. 5.Generators Name and Melting AddressGene Is Site Address(if different than mailing address) SA < f ,Gen h h . 6,Transpdrly f Odeiripffilyffift- U.S.EPA ID Number FR 'TFA R kf-W,FING 7.Transporter 2 Company Name U.S.EPA ID Number 8,Designated Facility Name and Site Address S ECOLOCII-Y U.S.EPA ID Number 9� .11 X11 S OF BEAT` H11M. Facility's Phone: 5 S."�-2 AFATTY, NV 8900-Z 9a. 9b.U.S DOT Desrriptlon(including Proper Shipping Name,Hazard Class,11)Number, 10.Containers it.Total 12.Unit HM and Packing Group(if any)) NO, Type Quantity WI.Nol. 13,Waste Codes 1 0 R 9'-1 VASI F-FIAM N 1� 2. 3. 4 .............. 14.Spacial Handling Instructions and Additional Information PRO.1-11 J-4DOT ERG 96.2 55 Mf PAM #M 933 0 4 1 WEAR KOER f+11#1-11 15. GENERATOR'810IFFEROR'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 labelediplacarded,and are in aa 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 atlached EPAAckpowledgment of Consent. I carlil'y 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. GanaratoesfOfferoes Printed/Typed Name Signature month Day Year –jof 16,International Shipments nis Export from U.S. Port .enuylexit: IL— El Import to U.S. Transporter signature(for exports only): Date learvl U.S.: LW 17.TranspoiterAcknowledgment of Receipt of Materials E2 Transporter 1 Prinledffyped Name Signature Month Day Year— 0 CL /4 VJ % z Trarisp4rter 2 H tediTy*Name Signature Month Day Yetir 18.Discrepancy 18a.Discrepancy Indication Space 1:1 Quantity El Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: i Ob.Alternate Facility(or Generator) U.S.EPA ID Number FsalitYs Phone: ju I Be.Signature of Alternate Facility(or Generator) Month Day Year !R z 0— 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) w LU C, 2. 3. 4. f20.Designated Facility Owner or Operator:Cor1cation of receipt of hazardous materials covered by the manifest except as noted in Item 18a Printedrryped Name Signature Month Day Year EPA Form 8700-22(Rev.3-05) Previous editions are obsolete.