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i Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form proved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1Jf3.Emergency Response Phone 4.Manifest Tracking NumberWASTE MANIFEST ' ) r' G B Fi s I i i {y. ;';':-'? '? �- 0,3 kz i,_,I k" 5.Generator's Name and Mailing Address Generators Site Address(if different than mailing address) ARI`Mli'•tf MAR f(;ORP t'5'%7t1:', M11l:Ii ie:.MV 1}A R f 11 IRAC Y,!..A v--3.�7i-i Generator's Phone.wj,.A'~:77>T 6.Transporter 1 Company Name U.S.EPA ID Number '3;ii:tiic.rii'ilfr'tf 11'Y vu.R';.ii• t;dt ,i•�i;. � nil pii3;'�;.�_+ti:' 7.Transporter 2 Company Name U.S.EPA ID Number t;EtN;1'f:i.E. :`?>;'f('."01.1 Y WAS 11'1- L1011111i: 4t.,It AX)I i titti l B.Designated Facility Name and Site Address U.S.EPA ID Number <'i::i Lk:fitt)ftt i:TiJ3i?tN 41'fiiti t1f unit s_# {ldli) t3l.0.111l53i4 tCnlra tli=iditt-lit);l.rR.E t4 'f t'i`t A t-Y.NV 894,118 Facility's Phone: .' • •.. ga. 9b.U.S.DOT Description(including Proper Shipping Name.Hazard Class,10 Number, 10.Containers 11.Total 12.Unit HM and Packing Group(if any)) 13.Waste Codes No. Type Quantity Wt.Nol. 1' i',Qlt3 3f 1'.y 9 Z 2. w c� 3. 4. 14.Special Handling Instructions and Additional Information 1'tff+t�li#:�fd•i+tiEs+frxill• VVftficf{k�If itiAi;k:t,;,A,ti (,{te+il+l':�f} t `. � 'r i.r r'16.1;fK'Y f.:s:14TA(.3-Writ i 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, id are classified,packaged, marked and labelediplacarded,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 Exporter,I certity that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a small quantity generator)is true. GeneratorslOtferor's Prinledrryped Name Signature ! Month Day Year J 16.International Shipments -- �+-+ z1:1 Import to U.S. ❑Export from U.S. Po f entry/exit: Transporter signature(for exports only): Date leaving U.S.: L= 17.Transporter Acknowledgment of Receipt of Materials � Transporter t Printedrryped,Name i Signature y Month Day Year O r , Transporter 2 Printed(ryped Name Signature Month Day Year � I 18.Discrepancy 18a.Discrepancy Indication Space Quantity ElType ❑Residue ParBal t2ejeCti . ❑Full Rejection Manifest Reference Numbe 18b.Alternate Facility(or Generator) U.S.EPA ID Number J LL Facility's Phone: "WRON LU18c.Signature of Alternate Facility(or Generator) �FQ A �'t Month Day Year Z TA�4ENT W Notice:State of Cal rn 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 0 1. 2. 3. fornia requires gernerator to phot copy and mail to Fndsf'ryp nated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noed in Item 18a DTSC with 30 days' ed Name Signature P.0 Box 400 EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. Sacramento,Ca 95812-04001 GENERATOR'S INITIAL COPY