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Please' rint or e. Form designed for use on elite 12- itch typewriter.) I11�,,' Form Approved.OMB No.2050-0039 P YP ( 9 ( 2-pitch) YP ) PP UNIFORM HAZARDOUS 1 Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number �+ C C WASTE MANIFEST CALJ�I 0383766 i-£ .c,r•e. �rT, OOvVVU3vo rLC 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) 1)G t lit General #14353 1)7 1 ' rG e i i e i '43 5 3 _ 75 r` '?1.5 F `0 E� 1TE Al ' 4 E 'YTtSFr+iITE f?`,'E. Generator's Phone: M N ECA, CA 95336-5923 �4�a:��A� �1-t `3`,.=vim i�8 6.Transporter 1 Company Name U.S.EPA ID Number BTtE. vtPe 1 .it as_ct2 ljtJ* .13LL 1:" 7.Titer 2 CompNam jr7 J �lY_� ��1G`✓1 8.Designated Facility Nate and d rens 2ISt Century EMN, f_t_I~ U.S.EPA ID Number Fernley. NV 89408 Facili F's Phone: r 7';'_ `r=` I N ga, 91b.U,S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes HM and Packing Group(if any)) No. Type Quantity Wt.Nol. x. 1)J _1` Z)0, .;Rte rtcroc_31=, fl_MMm ale c. 1, ERG#126 I 'f l' 00014 P 3.31 D001 O WX 21IN1 ,91. til—Am-'Fe HYpOi1i1Qrite Scl# tions 8. !='t.; l C'F 'u'_f0CA I J' 1_ i2; III, ERG#154 3. 4. 14.Special Handling Instructions and Additional Information a 1 1054 1 A e r w v 0 ? 15. GENERATOR'SMFFEROR'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 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 Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. I certify 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 genera is e. Fars gna on ay Year �wz�, Ct�� I ! I �6 01 Inlem a1 Shipments z ❑Import to U.S. ❑Export from J.S. Port of en}�lexit: ran lure for exports onlv): /N Date leaYtftg U.S,: LW 17.Transporter Acknowledgment of Receipt of Materials Transporter 1 Printed/Typed Name Si ature) Month Day Year COL Ar;rho lv Mad",-7L H I �\_/ L1Y/ I i i Ur2 Prin y�e Name � � Mpn DZ rear 18.Discrepancy 18a.Discrepancy Indication Space ❑ QuantityType e ❑Residue Partial Rejection Full Rejection Manifest Reference Number: 18b,Alternate Facility(or Generator) U.S.EPA ID Number J_ V LL Facility's Phone: L@ 18c.Signature of Alternate Facility(or Generator) Month Day Year Z I I N19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) G 1 ��` l' I2 �\ I3. 14. 20,Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Prtnledryped Name Signature Month Day Year EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNA�D ACILITY TO DESTINATION STATE(IF R&WIRED) y 't i'y` �� i �' 7a Ya'` vt tt// 7 r : a i7t( '^ L2t,,i CA .��t+17,17.:..ZI 2 154 71.e' cP, t 1 0� ter. ' � 1 - - - `