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Please print or type.(Form designed for use on elite(12-pitch)typewriter.) r�✓�!�— v Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergenc Response Phone 4,Manifest Tracking Number WASTE MANIFEST CAL00 107 1 800-424-9300 006396644 JJ K 5,eperat�l"".4V Mailing Address Generator's Site Address(if different than mailing address) �r� n tt i��G 10998 S. HA.RLAN RD. FRENCH"MP,C.A 955231 Generator's Phone: 209-9&3-6970 6.Transppoorter 1 Company Name U.S.EPA ID Number E'�ERGPEEN EPPRG�NbAENTAL SER'ACES CAD982413262 7.Transporter 2 Company Name U.S.EPA ID Number PHILIP'WEST INDUS T R!,AL SERVICES iNC. CAR00017752,7 8 geygr�tw�Qo Ntvcda F�cil lap 2nd Site Address U.S.EPA ID Number 1si U t� )t+�fvlrOv..rat�.tutna.Nr+c�t { ,LLG 2095 NEi'tLAfVDS DRl4`E EAST A7 Y'V7JLV xJ•3' FERNLEY,NV 89408 Facility's Phone T5.575-2760 ga 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit HM and Packing Group(if any)) 13.Waste Codes No. Type Quantity Wt.Nol. lwire- x ( y• l/N�9 ;qI 2. t "'l P zt3 3. I '� 4. 14.Special Handling Instructions and Additional Information ��/ protllF7-0 7-,?-00 erg (�K� drum size 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, marked and labeled/placarded,and are in ad respects in proper condition for transport according to applicable international and national governmental regulations.If export shipment and I am the Primary Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAdmowledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)C91 am a small quantity generator)is true. Generatoes/Offeror's Printecirryped Name ZSigta Month Day Year -j 16.International Shipments z ❑Import to U.S. ❑Export from U.S. Port of entry/exit: Transporter signature(for exports only): Date leaving U.S.: w 17.Transporter Acknowledgment of Receipt of Materials E Transporter 1 Pri yped Name Signature Mont Day Year a Z Trans p r 2 rinte ped Name ---Z- 94 re Morth Day Year �o r=te _ 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: 186.Alternate Facility(or Generator) U.S.EPA ID Number J U LL Facility's Phone: C3 18c.Signature of Alternate Facility(or Generator) Month Day Year Q Z w19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 0 1 2. 3. 4. 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered—by the manifest except as noted in Item 18a Pnnted/Typed Names__ VY�t Signature Month f D Y Ll 1 EPA Form 8700-22(Rev.3-05) Previous editions are obsolete.