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'Planta rvint K ivnn rFnrm ApeinneA Inr tree on elite f 12-odrh1 Nneyvriter.) <br />III IIIIIIIIIl111111111111111111111II II NI <br />0028440779KS <br />Form Approved, OMB No. 2050.0039 <br />- <br />r F _ r � <br />UNIFORMHAZARDOUS <br />1. Generator ID Num <br />zL�) ` <br />t <br />2 P e t of <br />Einer Response ?hone <br />'-R3 0�--4t: 760 <br />4. Manifest Tneking Number <br />002844077 SKS <br />WASTEMANIFEST <br />C'4I.0Z Lf�LJ1 <br />5 s Name and Maung Address Genereiols Site Address it d�enl rtran maliN address) <br />! b1o''� <br />cors Phor�: 2 4 16 <br />1 Name U.SEPA t0 Nume(6Tr <br />TXRC000 0934AT- Eh1c <br />7. Transporter 2 Canpany Name U.S. EPA 10 Number6.Oesignated <br />Faa ty Name and Site Add11666 11Ei t GI.lLC1t,Y NEVADA ) ,jkS RIO Number <br />it M 1 LF 3 f3 nF BEA`f T Y HWY 9 <br />BF: ATTY , NV r 90P.<3 <br />R s PJVTcs ;�f411�B00tt� <br />Facilays Phone: <br />gar_ <br />gb. U.S. OOT Description (including Proper Shipping Name, Hazard Class. V) Number, <br />10 cu)lalners <br />11. Total <br />Q. Unit <br />13. Waste Codes <br />No. <br />Type <br />At 1 <br />and Padtktg Group (6 any)) <br />Quantity <br />Wuw. <br />1 ,1011 Rt Rfl HPZ= AIRYKRISI Wer TE L IMODS <br />;;r, <br />1P <br />) <br />o <br />(ABSORBENT AND 01L.) <br />z <br />2. <br />LA <br />3 <br />4 <br />;.. <br />14.8pechtHartdrQInstructionsandAdditionalInformation SK 4, 4Y.M.07}200591 <br />U-7ty p6b1 —4iy�/ <br />— OFITRfX i #941.38) <br />r.z. tint 111--'131100-[ 6 -.1.7;;0 (SAFETY.-K(-EEN C <br />•.q.. <br />FAJFISFQ1IFK1T CARRU-M,(3' qr. e. . <br />15. GENERATOR S(OFFERORS CERTIFICATION: I hereby declare that the contents of this tbn*nment are fully and accurately described above by the proper shipping name, and are dassifidd, packaged, <br />marked and Iabeledfplacarded, and are in ad respects in proper condition for transport according to applicable Internal al and national goyeinmental regulations. d export shipment and I am % Primary <br />Exporter, i certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Cknsant. <br />I certify that waste mtnlntization sutemenl identified in 40 CFR 262.27(a) (d 1 am a large quantity generator) or (b am a small quantity generator) is true. <br />Ge ra s 4} MWyped Name .� igna a MDntjl, Day Year':1 <br />Yr <br />16. ternalto ipment3 Import to U.S. ❑ Expon from U.S. Port of entrylexit — <br />Z <br />Transporter signature (lot exports only): Dale leav ng US.: <br />W <br />17. TransporterAdmowiedgment of P.ecftl of Matetials <br />tY <br />Trans er 1 Printed/f Name x / <br />CL <br />NMonth <br />ZQ <br />Transporter 2 PrkdedlTyped Name Signature Day Year <br />- . <br />Q <br />F <br />16. Discrepancy <br />fee Disc epancy Indira) Space Quantity L__t Type ❑ Residue ❑ Partial Resection ❑ Full Rejection <br />Manifest Reference Number: <br />18b. Alternate Facility (or Generator) U.S. EPA ro Number <br />J_ <br />V <br />Faamy's Phone <br />tQi <br />w t&. Signature al Altefnale Facility (or Generator) Month Day Year <br />Q <br />z <br />19. Hazardous Waste Report Management Method Codes (.e., codes for hazardous waste treatment disposal, and roosting systems) <br />w 1 2 3. d. <br />O <br />20. Designated eacifity Owner or Operator Certification of receipt of hazardous materals covered by the manifest except as noted in Item lea - <br />rinled(Typed Name S gnatwe Mon h Day <br />rtf.�r•r me nr_ rY ei'tt itta�}'ti'f <br />EPA. Form 8700-22 (REv.)rJS( Pfevio6s editions are otisdete, Q <br />U♦=`Jll�Nl1I iCl l"/YLIt.i I T I V LIMA t tt•rsat ta_nv .,.a the 1 ttt nc,ti�� .•nr+• {)l <br />