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T11V <br /> print or type.(Forin designed for use orrelfte(12-Pltch)ty FormApproved-OMB No,2G50-003i <br /> us ��2.pqel WR EmaryancyResponeaft Tracidng Nurnber <br /> UNIFORM HAZARDO 15-823'4772 L0635957FLE <br /> WASTE MANIFEST <br /> -&-Qoemloes Name and Melling Address dZT(Rifferwiftrimaltingaddress) <br /> NpjG FiECI�CUf4C, Ath Wiiilaffl k4endMB. <br /> 5,EI Dorado St, <br /> Generator's Phona� 209-944-9555 <br /> TTFM—Wer IMM-Pany Name US,—EPA 10 Number <br /> [)qa 4 <br /> Up4on Paiift Lin"CC) 'Nf� � <br /> qyName U.S.EPA ID Number <br /> U.8,EPAJONumber <br /> ECDC 0,TIC-09,30 I <br /> I I I I 'West Hidhv.v--y'12 3 <br /> Facg 6 East Gwition,UT 84620 USA <br /> 9b,U.S;DOT DescrIption(including Proper Shipping Nam,Hazard Class,ID Number, 10,Containers It.Total 12.Unit 13,Wade Codes <br /> HM and PaWng Group(If any)) No, Type Qu-tity WILIVOL <br /> 1. 611 <br /> q,- W" WAS'Tv,SOUD fl�6--t-DOT retiulated) OD1 <br /> 0 HAZARD <br /> LLI <br /> zt <br /> Im <br /> 3, <br /> 4. <br /> 14.Special HsndH5j-1ftt6WSW alInformation <br /> MVVEFl&AL SeR�ACE-ReCYrUW PROJECT No, 6 YL 41 9 <br /> NaTi-RLRA WMef Kiskilife <br /> Ecacpr~4om its=5 <br /> ,5. eENERATOWSIOFFEROFVS CERTIFICAMOW,-1 hereby-dedars thatthe contents of this and zcWmteiyde9cribedab&abY the,prWAIPPIT19 name,and are classillied,,pacluilIed, <br /> marRad and I�Ibekdplacarded.and are In all respects In f6r transport acconliq to applic.abla.Intemational W ration6l govemmantal negulatws.9 export shipment and I am the Primary <br /> Exporter,I car*.that the contents of this consignment contiorm.to the terms of the attached EFAAcluiowledgmert of Consent. <br /> I.oarRyt4t the waste minlrob:ation statement Identified to 40.CFR 262.27(;)(k+Wjq-*e quanifty pnerator)of(b)(If I ST a NMI quzm*"WOOM&I ls�, <br /> W-nffi --Day ear <br /> -IJ <br /> 17 A MR- <br /> 1 16.International Shipments Impt to U'S, Por ofenbyle�t: <br /> Transpwef!�nature L exports only): Date leaviN U.S,: <br /> 17.Transportaf Aanowl4ment of Receipt of Materials --7---------JKW---::,.Day- <br /> U.1 W-5 r <br /> Transporter T.Priqtedflyped <br /> al <br /> (n 'Tr mom 'Day --Tear <br /> ansportef 2 PrintedfTyped Name <br /> 18.Discrepancy <br /> I Ba.Discrepancy Indication Spare Quantity Type ftwu. Partial R.Jection Full Rejection <br /> Ma0ast Reference Number. <br /> 18b, Generator) U S.EPA ID Number <br /> Facilivs Phofla� <br /> Day Year <br /> Lu otAfternate Facility(or Generator) <br /> S2 odes! codes for haxWous.waste treatment,4*UL and r6cYdillt W$tB=) <br /> I9.R=rdoAWasteP ad Meth0d C <br /> lisport <br /> W 4. <br /> M Desoiated,Facft owner or operstor Certification ofra*of hazardous materials wmad by tha manifiestumpt;mnoted In Item 18a <br /> Print0typed Na Signature jTth, P yea <br /> EPA Form 8700-22(Rev.M5) Previous edibonsma&60. DEWNATEDACOTY tO G'ENERAMR <br />