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r <br /> Sas -1811 �� �li�ll �il � MW <br /> Please PMtOr type-(Farm desiyrled for use on elihe{.12-pft),"WrihT.� 3341572-001 <br /> UNIFDRA[HAZA#i1�US- 1.Gorrerator ID Number t ii Fan JA d.QNIB No._205f1-0D35 <br /> 2 Page i ot- 3.EmetSoncy.f esparse Phone 4.1Aantlest Tracking NurnhCr,- <br /> �lvAsr ntarliFEsr CALODM91166 2 (8M Sn2sss 001994704 PSC <br /> F3WPHILUP <br /> hame and. 7ingRddress CneraiorS i1ek�}ress t different than mailing adA essJ <br /> LOTS 5TOF ES <br /> RD,A7TN:DI=NA Ft=[iAAEI BIG LO S#'191fi <br /> US,ON 43228(614j 27&27082720 COUN1RY•CLU13 DFHVE- <br /> olte STOCKTON,CA 95204 209r,#418M <br /> ransporter T L4rVrpyNMM <br /> . - U.S. <br /> S7 ERtCYCL PEC[AL?Y WASTIE SOLLMON5[NG IIRNSi)00110924 <br /> 7:Trarrspodet 2 UWY Name <br /> ` U-S.EPAID Number .. . <br /> 8 Assignmg h0ulnly me and Site Address <br /> 0 6 0) <br /> 21st Century EnWronmetitat Managermnt of Nevada LLC U.S.EP7iipNum6xr <br /> 211}99 Newlands Dr.East, NVIDWMQ 338 <br /> Fernley NV 89408 1(775)5_76-27W : <br /> FaMity'SPisone: <br /> ga gb.D.S.DDT i]eserfptzpo(induding IMper Shipping Name;Hazard 0ass;ID Number,. 1111.Cantaiaets <br /> "M. aid Packing Group.(t arty)) 11.7otal 12.Unit 13.' Waste Codes <br /> 1_ Ui<2810)AfASEE MAMLC UQU - Type Quantity- mMt <br /> IDS ORGANIC.N.O.HC?$(2.4-0]6.1:POF ' <br /> X31 D016- <br /> DF 53- P' <br /> 2- UNisowA37E FLAMMABLE UUMS.N-0,S-(KEROSENE,DIESEL)3 P611 <br /> W1 4 <br /> OF 48 p. <br /> 33I 005 <br /> 0007 <br /> 3, D�t1 o WASTEAEROSOLS2.i <br /> 331, t7001 <br /> 1 CF" S G <br /> 9. uJIMbb WASTE CORROSIVE UCWIO,BASIC,INOR GANIC,N.O.S.1`iOORJM HVJ)ROXrnFE <br /> PASSAM 1JYAROXIDE)6 PGit <br /> OT141 1k7p2 - <br /> DF 7 p <br /> '14.$pe A41andlirp hig acinos and Additional lnformalibn <br /> (1)BiTQ70C 0.1 :SAG <br /> "I§318LTO%fC-03.TOXIC MUMS 1.00SEPACK(2)BLFLAMLIQfi3-ERG(128)RAM1ulASLE LjWDS{3)BLAErii760LS-04-EfiG(i26)BEAEROSOLS 09-AEROSOLS <br /> {4}8LC(R�IBAg1C pit_ G(i54)BLCOiiItBASIC-04•BASIC CORROSIVE L wDs <br /> 15. 4I:f1t;RATOR`$/¢FFEROR'S CERTIFICATRA.I hereby declare that the contents of this cons�nrlent are fully and acourateiy described atrove by ft proper slVpirtg name,and are dassrTred,packaged. <br /> rirarked and lapeledfplw rn*d,and are in all respEM in proper Condition for iransport aocordrng to apptioab€e itlt national and nffiartal governmental regula4onS.if expod-shipmerrtatd I am the Primary <br /> Exporter,i certify that the co*nts of d,Is owsignment coafrrrriothe terms of the attached£PAAcknowtedgf wri of Camr L <br /> t-f*that rhe waste rrsnumation stablMent identifier{in 40 CR 262,27(a)(if I am a large quan*gmeraw or(bj{if I am a swE quantity generator}is(rue. <br /> CAMOWSJOtterors Pirtedffypffim— Sunature <br /> ar <br /> Irlternaiip11al5fsipments , <br /> !0 10 <br /> M Utmpm to U.S. El ExpW from U.S- Port ofen1:r0% <br /> Z 7rarls rter s dare tOr ex rte oN �"", <br /> Hate leavin U.S.: <br /> '17.TransporterAckbowledgnrentClfReCeiptofk[ateriaVs <br /> reTram Nrerr itt vyped Nante signatu _TW 7Ri7VbnIh <br /> IL ArwyYllii"rFa 10 t0 18 <br /> Q re e� <br /> -8.l3isrrepmy itia yf7 <br /> 18a:Q sc>apancy todation Space. Duan Type Ej Residue Martial Rejection Reiacfgn <br /> Manifest Reference Narnbar: <br /> 18b.Afiemate Facility(or Gcrera�r} U.S-EPA ID Number <br /> IU .. <br /> LL, 18c Sgn�ureofRltemaieFar4ily(cxGenerattxl - Mardh-= Day Year <br /> 19:!tatard6usWasteReporttAanagemecdWhodCod4sii.e rtidesi hazaiddns:wastedeahrefd dispose,and regcTn9sSsten'rs} <br /> 1- 2 <br /> -_H141 W141 <br /> 014 <br /> X.Qesgnased'Facility pwneror DR?raWr CerLlrcation of receipt of Ilazaldpus rrtaleniafscovered'hy the m�oTesti rCepuas,nD[ed_O item 18a <br /> Pr®1 ;pall Name -. 5i�na <br /> EPA Fvmi A70t�22(Rey.3-06}�?revwus editiail5 are�c>t�; - " - _ . . . <br />