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61416 of Calllomla—LIth and Welt"A040141 • Toslo 8ub�jarwi CH <br /> nt Dt ft <br /> pdM W trM (fora des/pnod for U11001)NNW(12-W)oh)"wdfW j SaasmeM0.o.nroml.' <br /> UNIFORM HAZARDOUS 1.Generators US FPA b Na- L Pegs 1 Inlomrtlon rey <br /> WASTE MANIFEST C l of 1 is not ng6lred y f�d6rr: <br /> h <br /> 1 6er*retorW Nart*W wlllhg AOdreM I <br /> 81 DORAD4 aw"CAL CO., DIC <br /> F.O. !OS Elft, STOCrM.G!___9$20i _ <br /> 4. 0er*ratoe,Phor*( 20f 1 466 S543 <br /> 4 <br /> 6. Transporter 1 Comped Nan* •. US EPA 10 Numbs <br /> UNIVERSAL ENGINEERING <br /> 7. Traraporar 2 Company Name l/S A `? <br /> l Designated Facility Wart*W SIo Addr ev l • UB EPA NunnbW <br /> USPCI GRASSY MDUNTAIN FACILITY, 3 MILES <br /> EAST, 7 RILES NORTH OF KNOLLS ;,IT ( y <br /> J -, <br /> 04F I $O CLIME UTAH U T D 9191 1tt3 4 8 <br /> Q.Conolrers 11 Total UN14. <br /> 11.US DOT Description(Including Proper Shipping Name, Hazard Class,and ID Numbw) Tot <br /> No. I Type f2uantlty wwd <br /> ` HAZARDOUS MASTS, LIQUIDs, ii.o.s., ORM E, <br /> r <br /> a WISP 0101 1 T <br /> a A <br /> T 141710( 0 <br /> • <br /> T <br /> n <br /> ilk.-A"U"DesddWi«ubr}lateny. et1A> a6 rat u _ r K �t�ifi9i <br /> KAM AATU 92%t SW ^S% <br /> US I.D. NO. F003 $ <br /> 15.Special Handling Instructions and Additional Inf tion <br /> i <br /> NEAR PROTECTIVE CLOTHING, GLOVES, SOOTS, PAGE SHIELD. <br /> 16.GENERATOR'S CERTIMATIOft I hereby declare that the contents of this consgnmMnt are fully W accurately described above Ity <br /> proper shipping home W we claaaifted,packed,marked,and labeled.W we in all respects In proper condition for transport by highway <br /> according to applicable Inemall00741 W rational govemn*nt h6Pulstbro, <br /> Unleu 1 am • small quantity generator who has been exempted by salute or regulation from the duty to make a waste minimization ceniflcatlon <br /> under Secilon 1002(b) of RCRA I also certify that I hors a program In piece to reduce the volume and toxicity of waste generated to the degree I <br /> Nae determined to W ehbnomicalfy Practicable and I Mae selected the MOtI290 of treatment storage, or disposal cunentfy avallable to me which <br /> minimizes the present and future threat to human health W the erMronmen <br /> Printedrryped Name �� SI Month Day Yw <br /> LARRY MCGOMAN10121019111 <br /> rftz <br /> T 17.Trensporter 1 Acknowledgement of Recegt of Materials <br /> Month a <br /> • fhtnted/Typed Name Sg to Y Year <br /> r <br /> 0 18.Transporter 2 Acknowledgement d-Recegl of Materials <br /> T Pdntedrfyped Name Signature Month Day Year <br /> *It <br /> 19.Discrepancy Indlatlon Specs <br /> F <br /> A <br /> e <br /> I <br /> L <br /> T 20.Facility Owner a Operator CedlBatlon of recelpt of haradous mataals hovered by this manifest except so rated In Item 19. <br /> Y Pnn lTyPW y'/"� SlgraI Month Vey Yw <br /> /. Ur NO(- G G <br /> DHS 6022 A(11/85) YELLOW TSOF SENDS THIS COPY TO GENERATOR WITHINAO DAYS <br /> (EPA 8700-2Z1 <br />