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793581 ni.,..... ......t nr hmc IGnrm rlccinnerr fnr nco .,.. olae li 9_nkfnhl hmauriterl i J Ir -g 60312 Form Aooroved. OMB No. 2050-0039 EPA Form tsruu-zz (ttev. d -u5) rrevtous editions are oosoiete. OESI aNA] {-,L) p-.A�U-J t Y i u utzo I jiwAi Yiw t) i Ar r- 11r nQ%a u3nt- r) n/ -1k.-0 P13 11 UNIFORM HAZARDOUS I. GeneralorlD Nairn W0,01Q3776 2. Page 1IoF 3. Emergeg%Wgnsz�F�of 7a5 . Manifest Tracking Number 1 001952716 JJ WASTE MANIFEST 5. GgA@Pr`QR0gEnd Mailing Address G%Vytor` ress (if different Than mailing address) 316 N. XAIN STREET 316 N. MAIN STREET LODI CA 952d0 (229)368-4691 LODI CA 95245 (299)368-4691 Generator's Phone: 6. Transporter 1 Company Name U.S. EPA ID Number 21st CEN7J-RY M C R000164012 7. Transporter 2 Company Name U.S. EPA ID Number e. Designated Facility Name and Site Address U.S. EPA ID Number 21st Century ENI 2095 Newlands Dr. East Fernley, NV 59408 (775) 57.5-2760 NM980895338 Facliry's Phone: 9e 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Containers 11. Total 12. Unit 13. Waste Codes No. Type HM and Packing Group (f any)) - Quantity Wt.Nol. 1. WASTE CORROSIVE LIQUID, ACIDIC, INORGANIC, R.O.S. (SULFURIC ACID, D@02 0006 U003 aR) LEAD) 8 UN3264 PGII RQ(D002) 1 DF G 732 rz z 2. LU ra 3. ; f 4. I 14. Special Handling Inshuclions and Additional Information (1) 116+225,1-80 - ERG(154) NICHL STRIP SLUDGE 15. GENERATOR'S/OFFEROR'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, marked and labeled/placarded, and are in all respects In proper condition for transport according to applicable international and national governmental regulations. If export shipment and 1 am the Primary Exporter, I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent, I certify that the waste minimization statement identified in 40 CFR 262.27(a) (f I am a large quantity generator) or (b) (If I am a small quantity generator) is true. Ge tor'slOfferoes PrintediTyped Name Si re. Month Day Year . "f l7 1 16. Internal' ne hipments ❑ Import to U.S. ❑ Export from.S. Port of entry/exit: tJ- z Transporter signature (for exports only): Date leaving U.S.: L= 17. Transporter Acknowledgment of Receipt of Materials Tra porter 1 PrintedfTyped Name�J It Signal a �1' Month Day Year U O 07 LL z Transporter 2 rinted/TypedName Signature Month Day Year d H _ 18. Discrepancy 18a. Discrepancy Indication Space ❑ Quantity ❑ Type ❑ Residue ❑ Partial Rejection ❑ Full Rejection Manifest Reference Number. J 18b. Alternate Fadtity (or Generatcr) U.S. EPA ID Number U -u £�clliiy-s-Ehon ...------- _--------------._ r w 18c. Signature of Alternate Facility (or Generator) Month Day Year Q Z 19. Hazardous Waste Report Management Method Codes (i.e.. codes for hazardous waste treatment, disposal, and recycling systems) LU 1. i L1 2. 3. 4. 20. Designat d Facility Owner or Operator: Certification of receipt of hazardous materials covered by the manifest except aj noted in Item 18a Printed/Typed Name )1 I �^ Signature ( MontDay Year EPA Form tsruu-zz (ttev. d -u5) rrevtous editions are oosoiete. OESI aNA] {-,L) p-.A�U-J t Y i u utzo I jiwAi Yiw t) i Ar r- 11r nQ%a u3nt- r) n/ -1k.-0 P13 11