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Please print or tvpe. (Form desianed for use on elite (12-oitc19&writer.) Is Form Approved. OMB No. 2050-0039 EPA Form 8740 22(Rev .3 Q5�_,erevjous editions are obsolete. GENERATOR'S INITIAL COPY UNIFORM HAZARDOUS 1. Generator ID Number ,a i s 2. Page 1 of 1 3. Emergency Response Phone ~Fx ' -'-f r -1. t 60 4. Ma(n�ife{st�Tlra�ckiQng (7 �(�1 30653 SKS WASTE MANIFEST V V G V 5. Generator's Name and Mailing Address Generators Site Address (if different than mailing address) CAL-7RANS le- Will@ CWS 16�^@(�3 `S B" TBp //i��ryry {{'' S' 4'�.Ffd�.i�. N 1. n t �4.�t^p~re4 i 6 Generators Phone: c: '_.e ^f F;-.7 e +• 31, 6. Transporter 1 Company Name U.S. EPA ID Number _ _ 7. Transporter 2 Company Name U.S. EPA ID Number 8. Designated Facility Name and Site Address US EMLOGY N ICA i y11151TVD Number i.1 MILES 8 DF BEATTY HWY 95 E4FgTT'Y NV $9003 _ �':�i9i....��ti i.#_..*'4'�`•�ne !V7P %��i�.tt.��YF Facility's Phone: ga• 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Containers 11. Total 12. Unit 13. Waste Codes No. Type HM and Packing Group (N any)) Quantity Wt./Vol. � k YA... Y..` ( 7 :Tii"(f. `•'?rte'. a.t..,ti.3 ^ WASTE .901,..L;J, Y` aJ*R )'Pi8 I, iii J' Z 2. L C9 3. 4. 14. Special Handling Instructions and Additional InformationSK 6 , i ` C° # atk e y 3 5:� J Cs10375 71 , w A / t,;,,RG# 171 A _ _ _ f+ Hr C. -SIN -469-17613 (SAFETY--(�L•E�•EN --�y�.€�^iN R�ACa�(irT��r13. ) yt;PERGENC'Y .`'V9 � il.J i H 0 q f. F_rt 7:`1 R tee ;t N, f._ k C ro ED W I. t'it�'!t',`_L.h�i�1C:N t Cf-'R'P 1F R AS IVT:t�.'t+F. SSRI R"Y 15. GENERATOR'S/OFFEROR'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 all respects in proper condition for transport according to applicable intemational and national governmental regulations. If export shipment and I am the Primary Exporter, I certify that the contents of this consignment conform to theaenns of the attached EPAAcknowledgment of Consent. I certify that the waste minimization statement identified.irkb CFR 262.27(a) (if I am a large quantity generator) or (b) (if I am a small quantity generator) is We. hefierators/OfferoevPdntedffyped Name Signature Month Day Year p v _J 16. International Shipments ❑ Import to U.S. F ❑ Export from U.S. Port of entry/exit: Z Transporter signature (for exports only): Date leaving U.S.: w 17. Transporter Acknowledgment of Receipt of Materials OTransporter Printed/Typed •Name Signature r Mont Day Year ~ CL QTransporter 2 Printed/Typed Name Signature Month Day Year F- 18. Discrepancy 18a. Discrepancy Indication Space ❑ Quantity ❑ Type ❑ Residue Partial Rejection Full Rejection Manifest Reference Number. 18b. Alternate Facility (or Generator) U.S. EPA ID Number J U LL- Facility's Phone: W 18c. Signature of Alternate Facility (or Generator) Month Day Year Q Z y19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) G 1. 2. 3. 4. 20. Designated Facility Owner or Operator: Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Printed/Typed Name Signature Month Day Year EPA Form 8740 22(Rev .3 Q5�_,erevjous editions are obsolete. GENERATOR'S INITIAL COPY