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Please print or type. (Form designed for use on elite (12 -pitch) typewriter.) Form Approved. OMB No. 2050-0039 UNIFORM HAZARDOUS 1 •Generator ID Number r2.Page 1 of 3. Emergency es one 4. Manliest Tracking Number WASTEMANIFEST011392884 FLE 5. Generators Name and Mailing A ress nera ors de dress (if different than mailing address) CVS (SIS) #16982 CVS (SIS)#16982 092350251 10424 Trinity Parkway, Suite H 10424 Trinity Parkway, Suite B Generator's Phone: 6. Transporter 1 Company NamerAt .S. EPA ID Number 7. Transporter 2 Company Name JNSID1312111 U.S, EPA ID Number 8. Designated Facllitq Name and Site Ad re L,1 5 t Century EMN, LLC U.S. EPA ID Number 2095 Newlands Dr. East Fernley, NV 89408 Facts s Phan 9a, 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, o N2811, Waste Toxic solids, organic, iii F 0001 P 311 D 007 DM Chromium, Selenium), 6. 1, PG II, ERG#154 Z 2. w 3. APR 0 � zols 4. )ENVIRONMENTAL HEALTH M. Special Handling Instructioris andAddihonel Information 1. 100196 (RX Toxic Solids > 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 labeledlplacarded, and are in all 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 EPAAcknowledgment 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) (if I am a small uanti generator) is true. Generators/Offerors Printed/Typed Namegna on ay ear J 11 Ng 6. International Shipments p_ ❑ Import to U.S. ❑ Export from U.S. Port of entry/exit: Z Transporter signature for exports only): Date leaving U.S.: IX Lu 17. TransporterAcknowledgment of Receipt of Materials 5i Transporter 1 Printed/Typed Name Signature Month Day Year o risto her Almanza Transporter 2 Printed/Typed Name i to on ayear r- 18. Discrepancy 18a. Discrepancy Indication Space ❑ Quantity Type Residue Partial Rejection El Rejection Manifest Reference Number: 18hi. Alternate Facility (or Generator) U.S. EPA ID Number U LL Farrli s Phone: 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) G 1. 2, 3, 4. 20. Desi a Facility Owner or Operator. Certification of receipt of hazardous materials covered by the ma ifest except as noted in Item 18a t me i a oath qay r EPA Form 70 -2 (Rev. 43�05Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED)