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• & Vu0 <br /> Please print or type.(Form designed for use on elite 12-pitch)typewriter.) Form Approved.OMB No.20504039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phones er <br /> t Track Numb <br /> WASTE MANFEST 10 4767 FLE <br /> 5.GawaWs Now and MaNklg Address GerwaWs Sae Address(ill different than mailingaddress) <br /> fXTGHt.`Sj' <br /> SiirnDs an Strt m _Ile Inc. OF ALL HALARDUII <br /> 5151 S AWOORRTTWAY ATERIALS BILLS AT <br /> s CA 96M U TALI WILL STICK <br /> Generaw5.Transporter I Company U.S.EPA I)Num - <br /> AdwncW Chemical Transport Inc. (SV) CAR000070540 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.DesIgnated Facility Name and Site Addrsaa U.S.EPA ID Number <br /> US Ecology Nevada Inc NVT330010000 <br /> PPO Bw U ,tiWY 59,11 Miles S Beatty <br /> Faci0ty'sPhoret 77&663,2203 <br /> ge. 9b.U.S.DDT Description(induding Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11,Total 12.Unit 13.Waste Codes <br /> HM and Paddng Group(R any)) No. Type Quantity Wtm. <br /> fJN2735,Amines,L pdd,CMU*e,N.O.S.,(AliphadccF 7 p 291 331 <br /> X Amines),9,PG II 3J <br /> W <br /> UX fJN2735,Amines,Liquid,COM38kre,N.O.S.,(r kilitaUc 3 CF lY l l p 331 <br /> Antilles),8,PG II <br /> W3082,Ealv�mlent)ally Hazardous SuhslanLe.Ugtdd, w p 331 <br /> X <br /> N.O.S..(Bisphenol A Epkj*wohydde Resin),9.PG® _I <br /> 4. <br /> i <br /> 14.Special Handling ktstn Iom arW Additionalnnfforr=Uon �� 145894 DDCUMw t At D1 752681 <br /> 1) 070131570-11831 6"p -03 z J* 3) 070131570-11845 Sill- <br /> z, 00,3,5»„83D sly v 3f 5-5-c <br /> 15, GENERATOR'SIOFFEROWS CERTIFICATION: I hereby declare that the cDnWb of this consignment are hilly wW accurately described above by the proper shipping name,and are des”.padwged, <br /> marked and marded,and are in al respects in proper condition for trar sport according to applicable Intern lana! rrmentat regulations.If export shipment and I am the Primary <br /> Exporter,i ow*that the eonteruta of this consOwnent conform to the terms of the attached EPAAdcnowledgnheni sant. <br /> I WDAVIV waste minimization t identified In 40 CFR 28227(a)(d 1 am a large quantity generator)WA)(I1 am a 9u is <br /> c JLJ ear <br /> IflAu <br /> 18. <br /> Import to U.S. ❑Export frau U.S. Port of lezit <br /> -* T for Date leaving U.S.: <br /> 17.TrxhspeterAclmowledgmerht of Receipt of qaterials <br /> 1 , jed New <br /> Transporter I Pnntsd/Typed Name Signalurs monthear <br /> 18.Discrepancy <br /> 1 as.Dlscrepaney Indicatlon Space ❑ Quantity ❑Type ❑Residue ❑Pallial Ruteatorh ❑Fudt Rejection <br /> Manifest ReWenoe Number. <br /> 18b.Altemab Facility(or Generate) U.S.EPA ID Number <br /> V <br /> LL Fadll a Ptharhe: <br /> 18G Signature of Alternate Faci(or Gerherata) Manta Day Year <br /> 19.Hazardous Waste Report Management Meted Codes(i.e.,codes for hazardous waste treatment disposal,and recycling systems) <br /> � 2. UO2-0 1 3. <br /> Mg I L/ I b6m I,* <br /> 20.Desigrwted Facility Owner or Operator:Cefification of recxipt of hazardous maoertals covered by the rnarifest axaept as noted In Item 1 <br /> Signakee Month Day Year <br /> tZ <br /> EPA Form 8700.22(Rev.3-05) Previous editors are ot>9dete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />