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1�zccr� 972$ 904) <br /> Please print or typo�forffttlestgtie: irge <br /> Approveii:,bMB No.165.(4.49 <br /> }•iienelak7f { aR 101 Emergency Response Phone : M rocking Number <br /> uNlFott111N ARt iiia"s� t 1 Z7)577 69 0017(�29 3 PSS <br /> WANE MANIFEST CA19 <br /> 5; neraktt s ame and m9 Ad t ahv s Sne Address ere0t than nWIN;address) <br /> g0.SS tE 1F@825 i* �t �g r r z', RDsS'S pht#(i82b <br /> aFissa x ;. �I OBBa YRINi r �KaMr <br /> svQcicl oN, 95219 io94z4ss�a <br /> svocn�lv,acn��al�Ik� R�� - <br /> UJ <br /> t;eneratars :PAI umrber. <br /> ransportet <br /> 6 let <br /> aiNsooaT10924 <br /> Z y J, x U EBA1DNumber: <br /> P10 <br /> t : <br /> A- <br /> U S E-PAIDNumber' <br /> Desipate <br /> n21st Centuiy tWronlln�ii �,of."Nevada I:i.0 NVD980895338 <br /> , <br /> 'ga U pOT n <br /> Kill Con <br /> Roper Sh pui9 Name.HazaN Clay$tD Num6 t,0:Conlamers 11.Total i 2:.Und 13 Waste Codes. <br /> anif.Paokfag hroup(d�+yi) <br /> W. _` Type` Quantity :.. :WL <br /> p� r 1 950 was. R '�i� ExcEEaNG 1 L caPAcr7v)z.s. _. - <br /> -�( <br /> P <br /> UNi> tN FkA�N1A8(E E101bDS N O 3 jACETONE)3 t�iti <br /> 331' DOb1 - <br /> - P <br /> 3 ` <br /> 0 <br /> - <br /> $ UNT@10 WASE UQUtOS ORGA N.O (LEAD ,LYER)B f PGN <br /> .._006 D008 <br /> . 331 D <br /> • .' �:- '. 2 17t', ` 170 P <br /> D014 D016 <br /> _4.Special Handling.nstructions and Aifdd oral Information <br /> OtRO60AERO.05-ERG02b)AEROSOLS!2 j#OSSPLAMI 5 ERG(t24)R AUKRAE1-OOSEPACK ' 4)ROSS6.1-05- <br /> ERG(tS3)FO70OLOOSEPACK <br /> -15. GENEPATOWS10FFERWI CERTIFICATION:i hereby declare that the contents-ofths consignment are fully and accurately'described above bydhe proper shipping name,and are classified,packaged. <br /> marked'and labeledfpiacarded,and are in atl respects in proper condition for transport according to applicable international and national governmental regulatOns.If export shipment and I am the Primary <br /> fxporter l ce*thatlhe conlinfs d this consignment conform to the terms of the attached EPAAcknowledgment of Consent. <br /> I certify that(he wazte minimization statement identified in 40 CFR 262.27(a)(Ki am a large quantity generator or(b)(if I am a small quantity generator)is true., . <br /> neratorsr n - Y f Signature. <br /> a9 ear <br /> '�f11 11 15 17 <br /> .j ntemational Shipments ��—'ft <br /> Z t_.xf lmpo U.S. Q Fscport from U.S. Port of entrylexit: —_—__-- — <br /> Tran rter.si nature for exports only): Date leaven U.S.: <br /> W 17.Transporter Acknowledgment of Receipt of Materials <br /> E Transporter 1 I mcled/ryped Name gn ure n ay Year <br /> a. Chris Gilliam 11 ) 15 ( 17 <br /> QTransporter 2 Prmtedrryped Name. f ignaturemonth- a e� <br /> 18.Discrepancy } <br /> 18a Discrepancy Indication Space Quantity ❑Type ❑Residue QPerm Rejection Of.,Rejection <br /> Manifest Reference Number. <br /> 1 Ob.Altemate Fadlity(or Generator) U.S.EPA ID Number <br /> J <br /> tV <br /> u� Facik s Phone: <br /> W. 18c.Signature ofAhemate Facility(or Generator) Month Day Year <br /> Q <br /> Z <br /> y19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,.disposal,and recycling systems) <br /> 0 1. H141 2. H141 4. H141 <br /> 20.Designated Facility Owheror Operator:Certificatiomof receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> PrintedtrYPed � <br /> N Signature Month Day Year. <br /> r <br /> EPA Form 8700 22(Rev.3-05)Previous editions are,obsolete. <br />