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2tz, tl� <br /> Please print or type. Form desiSged for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1,Generator ID Number 2.Page 1 of 3.EmergentResponse-Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST �°�� Gey �'7� 1 � 013452106 JJK <br /> 6.General0eg Name and MaifhrgAddr63s Generator's Site Address(if dffferant thmaill%address) <br /> ISD 00A� :12-02-w 3 �,. 14;5k war' <br /> IMVt3enorata's C H-0" 4S--e,"5 V y •3` -� d� L ~t7 rh 'q7�Y <br /> s.Tr EeMOU ENVIRONMENTAL SERVICES INC U.S.EVA <br /> 0 r0 0 1 7 1 0 1 7 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> W0r I e G'bv ejLGA v6 75" 47 ?s <br /> 8.Des1g�tLF�d'tlityf&jN�iteAddress U,S.EPA ID Number <br /> UUHWYGG955LL11UUCCMISSIIVVOCF• CY 16 ACRES <br /> BEATTY NV 89003 <br /> Facility's Phone: 775 553-2203 N V T 3 3 0 0 1 0 0 0 0 <br /> 92, 9b.U.S.DOT Description(Including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes <br /> HM and Packing Group(if any)) No. Type Quantity WLNoI. <br /> O 1 � <br /> yW i 9 <br /> 3� �t'��77i 1'�4� .aN�b�iceJO+ICJe oAl.c7 ,�cvily a �0� �Z3 <br /> q '+r 1�✓v1 I I.i 0 P <br /> 4. <br /> 14.SpaclalHarrfitnglnstrticilornuetxfAdaltfonatinfdrmatlon � <br /> v 410-70Z-7.3 991 -122-0; ly (tri s ®�eW( -,o)1-wiit, ! � <br /> P<m <br /> HANDLERS TO BE 40HR TRA]NED AND USE PPE..ER Contract#205907 <br /> 15. GENERATORISIOFFEtROR'S CERTIFICATION: I hereby declare thatthe contents of this consignment are fully and accurately described above by the proper shipping name,end are classified,packaged, <br /> marked and labeled/placarded,and are in all respects In proper condition for transport according to applicable international and national governmental regulations.If export shipment and I am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terns of the attached EPAAcknowledgment of Consent. <br /> I certify that the waste minimization statement Identified in 40 CFR 262.27(a)(If I am a large quantity goo toil or(b)(if I am a small quantity generator)Is true, <br /> rt go rot SIP ed N ffinth Day Year <br /> 107- 1 Mel 'Ito <br /> -Y 16.International ShlprnettEs r—} <br /> r-- Qimport to U.S. Export from U.S. Port of antrylexlt <br /> L Transporter signature(for exports only): Date leaving U.S.: <br /> 17.Transporter Acknowledgment of Receipt of Materials <br /> Trans ort PrlatedfipadN 0 signature Month Day Year <br /> PJ. <br /> TrWsp4orter2PrntedrrypedN me S. Month Day Year <br /> { <br /> 18.Discrepancy <br /> 18a,Discrepancy Indication Space ® Quantity ❑Type <br /> �Residue Partial Rejection El Full Refection <br /> Matiitest Refarar ce.Numbar <br /> 18b,Alternate Facility(or Generator) U.S.EPA 10 Number <br /> J <br /> V <br /> ;Facility's Phone: <br /> w 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> z <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> c 1. 1 2. 3. -� 4. <br /> M <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 1 Ba <br /> P nted ype ! Signature Month Day Year <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />