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Form Appmvd OMB No.7050-MY(Expim 9-3096) See instructions on matte or 3e 0. oepamnem al iovc Sehsnance:Co.,, <br /> Plime print or type. Tom deriprsd form m.lift(12pikA) _ Sarammrno,California <br /> UNIFORM HAZARDOUS 1. Genenver's US EPA 10 No. Morifed Document No. 2. Page I Information in the shaded camas <br /> WASTE MANIFEST CAD 0 9 5 6 5 4 2 7 3 , bat mrequired by Federal law. <br /> J of 1 <br /> 3. Go-a es None and Mailing Address <br /> r t I <br /> RV CircuitS <br /> 916 South Center Street, Stodctnn, CA 95206 <br /> ma c --wr P1 ant e (209) 546-9219 <br /> S. Tmttp~1 Company Nmsm A US EPA ID Number <br /> LeniVer9al MWircraenta1 <br /> C A 0 0 0 0 0 6 1 2 7 5 <br /> J 7. Tromparmr 2 Company Name 8. US EPA ID Number <br /> �U ^.aa <br /> Z 9. Wtlgnated Facility Name and Sib Address 10. US EPA ID Number <br /> 0 21st Century nin "y <br /> = 2095 Newlands Drive, East N <br /> Fernley, NV 89408 INIVID191810181915131318 <br /> n Z 11. US DOT Description(including Pam.,per Shipping NaHoned care,and ID Number) 12. Carnairnn 13. Taal WV <br /> t ol 't dei <br /> ate, Waste Carrosive Liquid, Acidic, Tmrigmic, Na. r Gaam6ty, <br /> 3 G m.O.S., 8, UN 3264, PG II,f.Nitric!Sulftsic; 1- it 7 <br /> r AIL <br /> Nb. SPds: <br /> N R B <br /> R <br /> V <br /> A <br /> m T C. <br /> S O <br /> EPA aA <br /> R <br /> W <br /> Z d. <br /> Z <br /> W <br /> V gr <br /> N <br /> Z .li' I Abovr °. ,.-...,. . <br /> O 'w <br /> d I <br /> N <br /> W <br /> tY <br /> J <br /> O 15. Special Haling I mingba and Additional Information <br /> `< Wear '_�rot-_ctive clothing as required 24 Hots canexgency Phone: 800-648-9931 <br /> Z --PG J154 Naticnat ; SP0nse Cater: 800-124-8802 <br /> W <br /> f <br /> -� 16. GENERATOR'S CERTIFICATION: I hereby declare that the confirm of thu comignment arc fully and accurately deembed above by proper shipping mare and ate clautfiad, <br /> J <br /> pocked,marked,and labeled,and an in all resperk in proper caditiah for transport by highway according in applicable irernotionol and notional gowmmer regulations. <br /> U <br /> If I can a large quantity generator, I certify that I haw a program in place to reduce the whima and tookity of waste generated to the degree I have determined to be <br /> economically practicable and that I haw mlecled dm practicable mmhod of treatment,mforage,or disposal currently awllable to me which minimizes the prerer and fntuw <br /> In threat b human health and the envirom em;OR, R 1 an a small quantity generpbr,I have made a good faith effort b minimize my waste generation and idem the bent <br /> wmN mcmgarrent meMsod that is available to me and that I cos afford. <br /> li�rmed/Typiid Nam, sign,,,' + Mach Day) Year <br /> u <br /> Z 1 17. Transporter l Acknerviledgement of Receipt of Mvlariols <br /> t� Printd/Typd Natne,7 % SioraN <br /> n. . r Day as <br /> m, 0 18. T Z A of AMbriab <br /> W t <br /> Mach Day Year <br /> Prinbd/Tyfriid Name Signature <br /> 0 E <br /> yWj 19. Discrepancy Indication Space <br /> U P <br /> A <br /> Z G <br /> 1 <br /> F <br /> 1 F2o. Fad Owner or Operator Gin ification of niceept of hmardaus materials covered by IN ...thea.ac en abd in Rem 19. <br /> T Priaad/Typd Name Spsobm Mach Day Year <br /> r <br /> DO NOT WRITE BELOW THIS UNE. <br /> DISC 8022A (1/95) Yellow: GENERATOR iETAINS <br /> TPA 8700-22 <br />