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Pleyse prinlor type.(Form designed for use on elite(12-p1 typewriter.) Form Approved,OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Ent cy Rg; onse,Pppgne, 4.Ma[[ys{{ite(�t7Tr clog ky r Rr� n cc <br /> WASTE MANIFEST C:l�1D981Es7,i0a,i t� i-'Mi-..! IE1W M 3J t' 4Vv FLE <br /> 5,Generators Name and Mailing Address Generator's Site Address(if tlli ferent than mailing address) <br /> GAN JUMN3KN RF.'G'ONAI.. TRAM!:•IT 1) SAN ,d43A111.JIN RF.610NA1.. 'TRAW)TT 0 <br /> fi'L) BIOX POJ 010 l*IN TRANS TT D1S1H1 :T 1.533 F. L..1NlDSPY ST <br /> I' RT <br /> ?:1l 951!"V RMq TRANSIT DISTR;CT <br /> Generators Phone: �'R19"r3Wt'-:i���£f: ::i1'flGl{iC11V K;A <br /> ani <br /> nor l Company Name U.S.EPA ID Number <br /> it -I•.TV--KI,F-F-N .'�Y�,Cd':MS, Yit(G„ ?'XR7it1$r�0��*fQ`it3111 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> S.Designated Facility Name and Site Address LIE+ E[iC11.KCfiY NEVADA U.S.EPA ID Number <br /> 1.1 MILF'S c OF WA'TTY HSWY `s <br /> Facility's Phone: BE:AT1-' NV 8900, <br /> NV T 3;'518 fl Q1&9klph <br /> ga 91c.U.S.DOT Description(includingProper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes <br /> HM and Packing Group(if anyp No. Type Quantity WI.Nol. <br /> z Y 1.HAIf3°>e`FX)W- WIS1F:'t 501 i1), Fd.ll. S !>q Et r,�0ry xsy <br /> ¢o (CIIPOMXUMd 9 NA3017 PC, Ii! <br /> K i ( <br /> w <br /> Z 2. <br /> W <br /> 3. <br /> 4. <br /> T - <br /> 14.Special Handling instructions and Additional Information �1)r ciFlJrf c' 1' E.O^`i1 - (.!SG <br /> c-. <br /> t)ER1a#0i f'1 ii <br /> 'k 'HR L41FAiENE-Y 1R1 di4)r ,. tEifl .1.dE�1 (SF'if=E`(Y'^-NL.FEKI 941,38) <br /> 11 .t y .. "It (N I 1 ' .C::-i 2 aLt..., ;.fir ...t. ..y f::' M'j -f'FSS .t ' <br /> 15. GENERATOR'SIOFFEROR'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. <br /> marked and Iabeledlplacarded,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 Mat the contents of this consignment confOrm to the terms of the attached EPA Acknowledgment of Consent. <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)It I am a small quantity,generator)is true. <br /> lueneratorsnOfferors PnWediTed Name igna ureon ear <br /> J 16.International Shipments <br /> ❑Impart to U.S. El Export from U.S. Potlofentrylexit <br /> Transoorter si nature fare arts and <br /> Date leavingU.S.: <br /> Ulu <br /> 17.Tmnspo ter Acknowledgment of Receipt o Materials <br /> Transporter l Pnnted,IYPed Name 1gnature ,.,_,y. �. onl ay Year <br /> O <br /> Q Transporter 2 Pnntedl7 dName I nature ,.. <br /> P Ype 9 Month Day Year <br /> K <br /> ♦ 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Panial Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> LL Facili s Phone <br /> w iBc.Signature of Alternate Facility(or Generator) Month Day Year <br /> a <br /> Z <br /> h19.Hazardous Waste Report Management Method Codes li.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 1. 2. 3. 4 <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> lPrinted/Typed Name Signature Month Day Year <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. GENERATOR'S INITIAL COPY <br />