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r Please print o�type. `' '' I form Approved.OMB No.2050.0039 UNIFORM HAZARDOUS 1.Generator ID Num er 2.Page 1 of 3.Emergency Response Phone4,Manife t Tr ck g u ert� WASTE MANIFEST 1Cjq�`,OC) -30 �,td Q Cs ,r <, 37 F L E 5.Generator's Nama:and Mailing Address r� .1 � ;�l (t Generators Site Address(if different than mailing address) qr� '.' d JA r4 c le C K Generator's Phone: 6.Transporter 1 Company Name I U.S.EPA ID Number opc- 7.Transporter 2 Company Name U•S.EPA ID Number 8.Designated Facility Name and Site Address U.S.EPA ID Number a i s-r r.rruR� a,��1t(�QA1rvt � A c. ov-,w t �� Nx0 cnc)' q 5 535" ��f5 NE,sa�Av�f�S OR rr=Arw-eyr,; N Y Facility's Phone: ga. 9b•U.S.DOT Description(Including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit HM and Packing Group(if any)) No. Type Quantity Wl.Nol, 13.Waste Codes z 2. pont, RC-QR p- A.:ZA9000S sal-IQ oyp LU �. �6 5 nR aPW-V 51 R AG 5 IX r i c 6 rhel OX t P d 4)0 3. '14.Special Handling Instructions and Additional Information tj 6J c,c-T- *4 /L/0 qo4l 15. GENERATOR'S/OFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,anal are classified,packaged, marked and labeled/placarded,and are in'all respects in proper condition for transport according to applicable Internatipn land national governmental regulations.If export shipment and I am the Primary Exporter,I certify'ihat the contents of this consignment conform to the terms of the attached EPA Acknowledgment of nsenl. I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or( (if I am a small q antity genera or)is We. Generatores/Offerors Pdnted/Typed Name Signature' Month Day Year L, � > 6.International Shipments ❑Import to U.S. El Export from U.S. Port of entry/exit: Transporter signature(for exports only): Dale leaving U.S.: W 17.TwsporterAcknowledgment of Receipt of Materials Transporter 1 Printed/Typ _Name Signature Month Day Year f I o `�' 1 CL Z Tr@pspoder 2 PdrlI d/Typed Name Sign e Month, Day Year iB:DIst:Ydpbncy: / ,, ' •. n. t � 18a.Discrepancy Indication Sped ,r❑ Quantity, ❑Type U Residue J j ❑Partial Re action FuILRe ecllon Manifest Reference Number: ' ' ' 18b.Alternate Facility(or Generator) U.S.EPA ID Number J a21 J CI-I'd'! of Nevada �- Facility's Phone: f W 18c.Signature of Alternate Facility(or Generator) r r a Day Year a for and wilt accept the wa to z 19,Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) C 1. ` t � 2. 3 4• 20.Desig ted Facility Owner or Operator:Certification of receipt of I)azardous materials covered by the manifest except as noted_in Item 18a \• Prinledrryp a to 4A _ Signature Moth Day Y ar�p EPA Form 8700-22 ev,12-17) 'r v'us editlons are obsolete.,,r DESIGNATED FACILITYTO GENERAT©R