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Please priuhorlype.(Poon designed forum on elRe(12-pitch). .,.Hriter.) fain Approved.04B No.2(150-0039 <br /> UNIFORM HAZARDOUS 1.Gene2tw ID Number 2.Page I of 3.Emergaxy Response Phone 4.MaNfaelTracking Number _ <br /> WASTE MANIFEST' 'a' r +_cr :,:tr, i� a- d_ - FLE <br /> 5.Generator's Name and Mailing Address Generaws Sire Address of different ban mailing address) <br /> 7r", .r'Frv-gy GrOLIP - -r Ower tO <br /> :0 3ojCj4r'aidrKS t€. I c3lis W. Pime:mhe Ave. <br /> n o, GA i58sd 901 e3£ mnlaea,CA SID <br /> f7! <br /> . mnspota anpany arae U.S.EPA ID Number <br /> 7.Tmnsporte 2 Company Name - U.SEPA ID Nanba - <br /> S.Designated Facility Name and Site Address - US.EPA ID Number <br /> U8 Eca!13qy� Nevada OpLratlons <br /> Ki&j vay 0, 12 miles& at 80-41vN/T33C709?QAi <br /> 9a. 9b.U.S.DOTOesalplbn pmjuft PmpsrShippng Nam%Hazard Class,IDNumber. . . io-conalnen - 11.Total 12.Unit 13.Waste Codes <br /> Fi61 and Packing Group(d enYu - No. - Type Ouarmy WtNd. <br /> 1. .-.. <br /> c Nun-RCRA Hazanlous Wacie, StAiA p <br /> w' 2. ._ <br /> 3. - - <br /> EC . <br /> <. EN RO ' <br /> LSH D PART ENT <br /> 14,Sperm Handling kWhaona enoAddsa;al Inlamaden _w>_:k.R ALL aPPROPRiA,TE S1:211787... " <br /> ERG# 171 Ahsorbent,Hoses. Fitters and TR`hEi2 CCN: 4 ?23v <br /> Misc. Debi's Corr rnirlated with Qa@di6e PERSONAL PROTEUIVE <br /> OF t F#` 07-012-WO-384q GL GTwtR,Cs.' <br /> 15, GENERATOWSWFEROR'S CERTIFICATION: I hereby declare that the contents Of ft wslgnment we"and a=Mfgly described above boo proper shipping name,are are damned,packaged, <br /> marked and abeledgWwded,and are M as respects n piopamnd bon for transport aaadkg a applicable memabonal and national governmental regJadons.6 exlhod shipment and I am the Primary <br /> Exporter,I certify ltat the oxtents of M omslpnment mnfam tote terms of the anatlwd EPAPclmoMedgment of Consent <br /> I oertiry,that the waste ninlakabon statement Wended In oro CFR 26227(a)(d I am a arye quantity generator)or(b)(d I am a generator)H true. <br /> cerneratursloffemc'sN;53T7pR '� Month BBI/ <br /> GI A Nr A Qc IBJ 1 <br /> LL::i 16.harnaWnal SMpnenM. El Import In Us. ❑Export from U.S. Port of aeyladt <br /> Y <br /> TransporW signature forDaa U.S.i, <br /> 17.T&nspwierAdmm%pgnentd Re2eO cf Meadale-. - r!, <br /> TraWorter 1 Pnnl as ear <br /> 1 !I <br /> Trasporter2Printedfry*Nana span lWonm W Tear <br /> 16.gaoapariry E <br /> t 16a Qsaepan y ln3wban SP�e .Q OIaristy ❑Reddue ' ❑Ptal eRela'Bm ❑Fug Rebwr9 <br /> L, <br /> ` Marhat Relelenoa Nwbw.. <br /> 18b.Alternate Fadty(or Generat)() _ U.S.EPA ID Numbs <br /> LLF aPlhone. <br /> w 18c.Sgnawra Xamaa Facility(or Genemmr) Month Dar rear" <br /> N19.Hazardous Wass Repel Management Method Codes(Le.,wdesfehsladousmsle treatment,disposal,andrayclong systems) <br /> �. 1. 2. 3. 4. <br /> 20.Designated Faafdy 0 mere Opmtor.C&tfmWn of receipt d hazatdom maWd&o YaMd by lha mankst exa;p M MtOd In tan tae . <br /> 11Ij slgnanae/� / Month <br /> Tea <br /> ,1461 <br /> PontedlTypai Name --- --- .. (.�/ Y i / ¢ R 1/ <br /> EPA Form 8700-22(Rev,3-05) Pqfibusedi6onsare obsolete. / �. . DESIGNATED FACILITY TO GENERATOR <br />