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218441.-20 ERI Previdel-. 3951493 <br /> Please print or type. Form Approved.DMB No,2050.0039 <br /> UNIFORM HAZARDOUS 11,Generator ID Number 2,Page 1 of 3,Emergency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST CAD009189069 3 (800) � 1000307764 DAT <br /> 5.Generator's Name and Mailing Address Generator's SiteAddress(If different than mailing address) <br /> Applied Aerospace Structure ` Applied Aerospace Structure <br /> P.O. Dox 5109 3437 S0. AIRPORT Vny <br /> Generator's Phone: Stackin CA 95206 (2091903-3339 ISTOCKTOR CA 95206 <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> STERICYCL.E SPECIALTY WASTE SOLUTIONS INC 1'INS0011311CNI4 <br /> 7.Transporter 2 Company Name U.S,EPA ID Number <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number <br /> 21ST CENTURY ENVIRONKMRL Ml10IGEMENT OF NEVADA, LLC <br /> 2145 Neulalnds Drive East <br /> Facility's Phone: FERNLEY, NV 04401 (775) 575-2750 NVD980895338 <br /> ga, 9b,U,S,DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10,Containers 11.Total 12.Unit 13.Waste Codes <br /> HM and Packing Group(if any)) No. Type Quantity W1.N0l. <br /> DIII DO03 551 <br /> 1. UN1396 VAASTE AL(WINUM PMER, UNCOATED 4.3 PGII <br /> 0. X car GF o9 P <br /> 9 <br /> Z 2. UN3262 VRSTE CORROSIVE SOLID, 11ASIC, INORGANIC, N.O.S. SODIUM 1102 551 <br /> X HYDROXIDE, SODIUM PHOSPHATE, TRIIHSIC) 1 P&Ii CF 14 P <br /> 3. UN2925 URSTE FLMILESOLIDS, TOXIC, ORWHIC, N.O.S. IDEINIS GIN S11 D1101 BOO? ➢035 <br /> X ACETONE, CHROMIUM) 4.1 (6.11 PGII 1100111) to DSI #e;-9 P F003 F005 352 <br /> 4, 977 HAZARDOUS UWE, SOLID, N.O.S. DEIRIS C/V CHROMIUM 9 D007 101 <br /> X P6III RQUID071 Fe-1— Dig -33-7 <br /> 3.7 P <br /> 7- <br /> 14.Special Handling Instructions and Additional information <br /> (1) 1559270-00 - ERM1301 LP 1 1 (2) 1651271-I11 - ERG(154) LP # 2 (3) GR191D-10 - ER6(134) SOLVENT VIP"ES (4) 681919-11 <br /> - ER6(171) CHROMIUM CONT. DE1RI �t� ,,�S'Gsa. C]) l X IO C:,Pn— <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 labeledtplacarded,and are in all respects in proper condition for transport according to applicable Intemationaland national govemmental regulations.If export shipment and i am the Primary <br /> Exporter,i certify that the contents of this consignment conform to the terms o€the attached EPAAcknowledgment of Consent. <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(ifi am qsmall quantity generator)is he, <br /> Gene€aloes/Offeror's Printedrryped Name I—SwlA _ alure Month Day Year <br /> _j 16.International Shipments A <br /> � ❑Import to U.S. ❑Ex from art of a try/exit: <br /> Transporter signature(for exports only): Date 1 Ing U.S.: <br /> W 17.Transporter Acknowledgment of Receipt of Materials <br /> Uj <br /> Tran rte,1 Printedrryped Name a Month Day Year <br /> �. <br /> Transporter 2 Pdntedfrypod Name S ature VMonth Day Year <br /> 5 <br /> 4 <br /> 18,Discrepancy <br /> Ise.Discrepancy Indication Space ❑ Quanfl� Type El <br /> ❑Pallial Rejection El Full ReJeciton <br /> Manifest Reference Number. <br /> 18b,Alternate Facility(or Generator) U.S.EPA ID Number <br /> .a <br /> 5 <br /> Facility's Phone: <br /> W 16c.Signature of Alternate Facility(or Generator) Month Day Year <br /> a <br /> z <br /> 19.Hazardous Waste Report Management Method Codes(W.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 2, 3. 4. <br /> 1. 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> PrintedfTyped Name Signature Month Day Year <br /> EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM <br />