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Y:t;sa p,.n1 e•t;pe. Farm Approved.OMf3 Na.2650-W39 <br /> I Generator Ip Nurnbar 2.Page 1 ci Eme R Phone �. i125t I ae u be <br /> uNrFpRrd HAIAI2i1pUs �s rgarxy esPonse �1 g �. �•. <br /> WASTE MANIFEST C.#.. (100 M.540 ;, I 510-Ul--21 ZB 1� M - 5 2-4 F L E <br /> 15 Ger>QwVs Name and Ma ng Address Generator's Sire Address fit different than marling address; <br /> 4"n Stide Uxmbw Into T , <br /> 301 S Airl"R d <br /> G„Nown. Cit 95208 209-M-7700 <br /> 6,Trarmpdrier 1 Company Name U.S.EPA ID Number <br /> Big Sky EwAronmeaiai Sokitimis C-AL 000 :tee 010 <br /> 1.Tref porter 2 Company Name U.S.EPA ID Number <br /> �� �Fldf f�311�S��iF1Ge. MIK 430-Q_4?.74Z <br /> Ns.,rvt-d Fac:,fly Maine am Site Address U.S.EPA 10 Number <br /> US EcoWgy NevadaNON V- 330 010 OW <br /> Hipiwrtty9511 man"Ain of Ssalty r <br /> Fa INV 8"4 <br /> ya 94.U.S.DOT Description(Including Proper Shipping Name,hazard Cla%.ID Number:- 10.Containers t1.Total 12.Unit <br /> Hp.1 and Packing Group(if any)} . No- Type Quanbly Wt.Nol. <br /> T <br /> UN 1943,Waste���r4U1d; M.6s' <br /> 76� ��� <br /> tx L <br /> W <br /> urr - <br /> �4eft*"=d <br /> . t,Ioki_ C. 14 R OCA <br /> �{ +taw �� 1 <br /> I <br /> 14.Special Han&ng lnslruUns and Addrllonal Infgrmation. <br /> G }62 <br /> ti <br /> JON ffk H3 ���I3I ,�J• � � ' %,q p20M5T)-h5V <br /> rt""s;5!cf"Mmd: Jeff Rlhff6ft 5 0-MI-2178 <br /> a GENFRATOR-SIDFFEROR'S CERT IRCAMN: I hereby declare that the contents of this con4nrrent are fatty and a=ratefy deschbed above by the proper shipping name,and are dmsitled,paskagad, <br /> marked and fabeledrpfacarded,and are in all respects in proper cond•tion for transport according ld applicali a international and naWnal govommeiV regulations-If export shipment and I am the Primary <br /> Exporter,I cerlify that the contents of this consignmenl conform to the terms of the altac hod EPA Acknowledgment of Consent. <br /> certly that the Waste rninOt7.aW statement idem!fled in 40 CFR 262.27(a)(if t am a large quanU eralw}or lbI(if I am all quantify generator)is true. <br /> Geri rotas S'Qtferor dntodTypad Name Month ' <br /> Yea: <br /> 167 <br /> l6.lnternatrMal Shipment y❑ ' - _Impaft kp' ❑Ex'. Pert of enryiex L <br /> ? Transporter signature(for exporls onlyy: �r _'?� Dale leaving U.S.: <br /> M )7.Transporter Acknowledgment of Receipt of htalerials' <br /> tom- Trass,'wrter 1 Pontedffypel Name Signature Day I Year <br /> Z T,-ansYarler 2 Printedfl' NameSigrialure `~ Meant Day Year <br /> 16.Discrepancy <br /> 'ea.D-aeparq Indication Space ❑Qu,* ❑Type ❑Residue ❑Partial Rejection l rI FSA Rejec. <br /> Manifest Reference Number: <br /> t? '�b Vemate Faaldy[or Generator} y!y. US.EPA ED Number <br /> U ' <br /> a <br /> 1 P,c S'-3na!ure of Atteirsaln Faa::ty(CI GenefatrXf .,dw' t MGnth Day Year <br /> N19.hazardous Waste Re"rt fdanagement Method Codes ri-e.,Bodes for hazardous waste Ueatrnerrt.d spowk,and recydrng systems} <br /> WC <br /> 20.PesTated Fac.My Owner or Operator-.CertifrcaWn of receipt of hazardous materials covered by the manifest a Wt as nded,in Item ilia t <br /> Pri d N <br /> T <br /> EPA Fori$7 (Rev-12.17) Previous editions areobsoletA DE5fGNATED FACILITY TO GENERATOR <br />