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State <br /> of California—Environmental PrpfectiOn Agency t Cx <br /> Form Approved OMB No.2050-0039 f Exp�jss 9-30.991 See In4truCti9ps on <br /> Rlpa !q 4 �oxi4;5ubstances 4optrol <br /> Please print or type. Form designedfor use on lite,f 1?-pdc tit r - 7 . $ Egpyptq,California <br /> t a <br /> enerarora l► ogUNIFORM HAZARDOUS !> Infonnatfgn fn tllt;hgded.arw <br /> O, D O 6 8 sq►fqw.WASTE MANFEST s <br /> drau <br /> 3. Ge LR.tj,Xo Ytd r Ad <br /> F318 S. S7'AIN.T.S[AUS TlRM, <br /> n 4. Generators Phone f�Tul t�A 95206 (209)948-2768 <br /> C4 <br /> 5. Transporter 1 Company Name 6. US EPA ID Number <br /> a0 . <br /> (,'D l.JRY EI.T 0 0 1 <br /> of <br /> 7. Transporter 2 Company Name 8. US EPA ID Number tj�y S <br /> I�'J �p+��'Y;5 3i'r• <br /> St <br /> U 9 Desi net d Faciliy Nam Site Address 10. US EPA ID Number13 <br /> h: <br /> Z 2095 Newlands Dr, Fast <br /> 000 f'efrtl.ey, NV' 89408 <br /> N V 91 EIi <br /> Nv 1 1. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) 12''metal -'F'�„t V - <br /> No. T "Quantity Wf/ ol <br /> RO BASTE CO 1051VB LIQUID, ACIDIC, INORGANIC, X.O.S. (SULYUHIC <br /> 3 G KID, IICKEL SU,PA761 8 013261 PG11 401121 SIG(154) T p G <br /> o E b_ oU /�t /91�1:5aUS LXlf�.S 7� /,>/ <br /> o N <br /> f. <br /> N R fV tif�h rl 1 NM 307 <br /> n- <br /> v A _ <br /> o T <br /> , <br /> CID 0 <br /> R PVj/Y.is rs <br /> Uj d <br /> Z ENVIR0NIN EN HEAUN <br /> V <br /> w PER1,41,1T'S"R VI r Rq <br /> J. <br /> Z <br /> �'S4'�'1pf p Q t{PC s -2 iitl841-2 i <br /> °LLJ <br /> X � <br /> o< <br /> 15. Special Handling Instructions and Additional Information <br /> 080 ?A0k91 P10TECTIYS Cl,01HiNG, INFAGWY IBSPUSS FWNE (641) 567-7455. <br /> Z <br /> w <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classilisd,packed, <br /> V marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international und,nationgl ggxlrnment regulations. <br /> ''.k9, 41,,4 <br /> -+ IF I am a large quantity generator,1 certify,that I have a program in place to reduce the volume and toxitlty oPwgipt generofed tq the.dlgrest haw determinstd to be:economically <br /> °- practicable and that 1 have selected the practicable method of treatment,storage,or disposal.currently available to me which minimizes ptysegt and Future threat fp human health <br /> N and the environment;OR,if I am a small quantity generator,I have made a good faith effort to minimize toy.waste generation <br /> O <br /> available to me and that I can afford. ! �!b•s1:Nash monggement method that is <br /> Printe� r� Signal77 77ftlpnth ayeal' <br /> Z )I-• <br /> LU RT 17. Trans orter 1 Acknowled ement of Receipt of Materials <br /> �j A Prj ntod/Typed Name <br /> S i r/ f �^ y ear <br /> w • <br /> O 0 18.'Trans orter 2 Acknowle ement of Receipt Materials <br /> R Printed/Typed ed Name ` . ..-_ ., ..... <br /> T yP Signature Mo t <br /> LU E p h, Day Yew <br /> Q R <br /> 5 _ <br /> U F 19. Discrepancy Indication Space "-'"- - ' s •. . <br /> Z A r <br /> C isv: <br /> I .. <br /> L r r <br /> f 20. Facility Owner or Operator Certification of receipt of hazardous materials covered by this manifest exce t as noted i demW2 r ' <br /> T Printed/Typed Name Signature ;t iF Month; Day year <br /> `� <br /> w. ...; z ' <br /> DO NOT WRITE BELOW:'T USE, <br /> Y,lo": TSDF SENDS THIS COPY TO GENERATOR WITHIN 3O DAYS. <br /> DTSC 8022A (1/99( (Generators who submit hazardous waste for transport out-of-state, <br /> EPA 8700-22 produce completed copy of this copy and serd to DTSC within 30 days.) <br /> 12-16-05A11 : 40 RCVD <br />