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/[..... Al A r.. nliln r11i it hl h <br />III 1111111111 1111111 II 111111111111111111111111 <br />002844077SKS <br />Form Approved. OMB No. 2050.0039 <br />EPA Form 8700-22 (Rev , 13(ekolis editions are o solele. <br />Di IG NAT FACI1.11TY TO E3F:, I INAI S7ATL It nt i <br />as, r •� <br />UNIFORM HAZARDOUS <br />1. Generator ID Num rp 2. P e 1 of 3. E ei my Ri sponsi'hb�r <br />t � � w9 <br />4. Manifest Tracking Number <br />002844077 SKS <br />WASTE MANIFEST <br />G94 wdo o J <br />5-4nergor's Name and Mailing Address Generator's site Address (it different than mailing address) <br />C..� �(S� <br />✓`�tt,..., MMAP,3 20114 <br />Genefirator's Phone: -7, a `t3 3 Z <br />6. Trans _ , er 1 Compen!FN U.S. EPA ID Number r <br />f r-,r'�rrTY--K_.f . ISY9TrP-ms, i ENVIRONMENT rx � �� , ,. <br />7. Transporter 2 Company Name MAUR IMPARTMENTU.S. EPA ID Number <br />8, Designated Facility Name and Site Address US ECOLOGY GY NEVADA 1 �111S_M41D Number <br />1'.. MILES ,c OF BEATTY 1AWY ''1:5 <br />k)E�:AI�'TY , NV pr.3�f03 <br />( �('_ 'ry 7, .r �7�}7 h��h <br />S3 S't{J•._1,�. 1,•`•,J 7'Gi �J NV 1 ��.:!*fJirJJ.'UL` 00- <br />Facilit's Phone: <br />9a. <br />9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class. Io Number, <br />10. Containers <br />11. Total <br />12, Unit <br />13. Waste Codes <br />No. <br />Type <br />HM <br />and Pecking Group (if any)) <br />Ouanfity <br />NI.Nol, <br />1 IgQN fr'MR.A HIP7.f1F2T?MIS 41A,3TE L..IQLJTDS <br />o <br />(ABSORBENT AND OIL) <br />Z <br />2 <br />LU <br />3. <br />4 <br />14. Special Handling Instructions and Additional information SK SFI T.P#804 x:00591 CSG <br />u-7qNG)G(A —key <br />::Prii:.l�t_r+ ;tit ` :I. ta�hG� 4t�Et 17,�b3 ( A ETY—KI_E LN — C)i�!'1'stACT #94138) <br />p. _ ..... <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 labeled/placarded, and are in all respects in proper condition for transport according to appllcabie intemali al and national governmental regulations. If export shipment and I am the Primary <br />Exporter, I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of C nsent. <br />I certify that t e waste minlmization statement identified in 40 CFR 262.27(a) (d I am a large quantity generator) or (b lama small quantity generator) is true. -' <br />Ge rat Ifer s. mted1,/Typed Name ,�1 iro` igna aMon ?�`r <br />_ r <br />16. nlernatio hipments ❑ Import to U.S. ❑Export from U.S. Port of entrylexit: <br />Transporter signature (for exports only): f Date leaving U.S.: <br />W <br />17. Transporter Acknowledgment of Receipt of Materials <br />� <br />Trans er 1 Prinled/T Name tgn r '• � "' <br />CL <br />RTransporter <br />2 Printed/Typed Name Signature Month Day Year. <br />H <br />18. Discrepancy „ <br />18a. Discrepancy Indication Space Quantity ❑ Type ❑ Residue ❑ Partial Rejection ❑ Full Rejection <br />Manifest Reference Number: <br />18b, Alternate Facility (or Generator) U.S. EPA ID Number <br />Q <br />U <br />;4 <br />Facilily's Phone: <br />hlonih Day Year <br />18c. Signature of Alternate Facility (or Generator) <br />4W <br />Y <br />y19. <br />Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) <br />1' <br />2. <br />3. <br />4 <br />H03 9 <br />20. Designated Facility Owner or Operator: Certification of receipt of hazardous materials covered by the manifest except as noted In Item 1 Be <br />rinted/TypedName Signature Moruh Day' ; ear_ <br />EPA Form 8700-22 (Rev , 13(ekolis editions are o solele. <br />Di IG NAT FACI1.11TY TO E3F:, I INAI S7ATL It nt i <br />as, r •� <br />