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_:•_., , ) A ) - .� S - Form ADDroved OMB No. 205MO39 <br />crease <br />nt a tram ores nes tvr usn vn ou+n +�- �+�w �yPo.,�o•r — — - � — — <br />1. Generator 10 Number 2. Pape 1 of 3. Emergency Response Phone 4, ManKeet Tracking Number <br />UNIFORM HAZARDOUS <br />1800-424-93OD-CHBMX-c 0 0 4 8 2 4 3 8 7 JJ K <br />, 2 <br />WASTE MANIFEST L L % <br />5. Genaratort Nemo and Mai Address Gerwralors Ske uT dtf nl than mailing addreae) <br />v /►�o�l'l U19 !mss 3 /V.T!f oRNTo N RD <br />Generators Pnone: 3 U.S. EPA ID Number <br />6. Transporter 1 Ccmpar+y Name <br />FRE%KXMENVIROt1AENTAL SERVICES INC. Phone * SW539.3274 CAR000171017 <br />7. Transports' 2 Comparty Name U.S. EPA ID Number <br />21 at CENTURY ENVIRONMENTAL MANAGEMENT OF NEVADA, LLC CAR000164012 <br />B. Designated FaciRy Name and She Address U.S. EPA ID Nunba <br />21 ST CENTURY EMI NVD980895338 <br />2095 NEEWWLLAANNDS DRIVE, EAST. <br />FERNLEY, -1- 89408 <br />Factlil es Phone: 775-575-2780 <br />98 <br />9b. U.S. DOT Description (hduding Proper Shippng Name, Hazard Class, ID Number. <br />10. Contalners <br />11, Total <br />12. Unit <br />13. Waste Codes <br />No. <br />Type <br />HM <br />end Pacicing Group (r any)) <br />Quantity <br />W11Vd. <br />1 Nort-RCRA Hazardous Waste Sold (Oly Debris) <br />C> 0-1 <br />DM <br />a S <br />P. <br />Zn <br />2. <br />c9 <br />3. <br />4. <br />14. Special Harding nslruc8orm and Additional Information <br />Wndm to betrained tttad use PPE.' <br />9bl) 386188-00ERG d 171 <br />15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare That the contents of this consignment are fully and accurately described above by the proper stopping name, and ere dasstW, packaged, <br />for transport Io appkeaWk nternall"l and natlonal goven mental regulations. If export shipment and I am the Primary <br />marked and hbekdWacarded, and are In et respects fn proper, oondrdon axording <br />Expoder, I =* tlud rhe contents of this corulgorr"t conform to the terms of the attachad EPAAckrww*dgment of Consent. <br />I cK* that the waste minimization statement IdeM ad In 46 CFR 26227(a) (d I am a large quantity generator) or (b) (dl am a small quantity generator) Is true. 1 <br />a P twill Signature Month ear <br />Geky <br />a <br />Ix aKSLArt <br />16.lnWnauonal Shipments <br />❑Import to U.S. ❑Export from U.S. Port of entrylexrl: <br />_ <br />Transporter lignature (for exports only): Date kavhg U.S.: <br />17. TransporkrAdowwkdgment of Receipt of Materials <br />Month Day Yoer <br />rinl <br />Transporter 1 PWyW Name <br />Signature <br />a ° <br />Dai' ALL <br />�' <br />Sigratrae Monty Day Y <br />0 011) <br />TrenWfler P' ypedN <br />18. Disaepency <br />18a. Oi"ancy w aom Space ❑ Quandty <br />❑ Type ❑ Rea{due ❑ Partial R.,olon ❑ Full Ra do. <br />M&OW Rsfennca Number. <br />18b. Allemals Fadbty (or Generator) <br />U.S. EPA ID Number <br />ski <br />Fad lys Phone: <br />18c lure FaclRy (a to) <br />Month oay YON <br />g� <br />19. Hazardous West$ Repot Manegemaint Method Coda (I.e., <br />es fa herardous waste heatment; disposal, and recycling systems) <br />1. i ' i <br />2. 1 3. <br />4. <br />20. Designated Fadtty Owner a OperatDr. C*rMm ton of r I0 of hazxdou$ m$t"le covered by ft meNfal except as noted In Rom 18e <br />EPA Form 8700-22 (Rev, M5) Prevlous eftns are obsolete. DESIGNATED FAdOTY TO DESTINATION STATE (IF REQUIRED) <br />. _1 rr=rt(r—(t'-)Atli) ::)t. K C V D <br />