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01/26/2010 12:44 FAX <br />PIe909 pHnl or "a_ (Forth designed rdr use W elite (12-Nkch) typo wr.) <br />16 015 019 <br />DOC. 0Ek533- 1077 <br />Form ADDroved. DM9 No. 20500039 <br />` <br />UNIFORM t16'LARDOUS t. (5Qmmic, lD Number <br />2_ Pep 1 a <br />3. Fmegemy Fumv a Pnow <br />C aanrfeat TrikIng Nmber <br />WASTE MANIFEST CAL000256612 <br />1 <br />600-747 <br />000237745 JJ K <br />6, Generators Name ane Walling Mdrm Genendora 514 Address M delerant Nan malleq addrceel <br />Tower Mart Store 6104 <br />809 Market St - <br />CONSa,CA 95932 - <br />Germraora Ph"; 916-285,7402 <br />6. T1an1DOR1! 1 Company Name U.S. EPA ID Number <br />UNIVERSAL ENVIRONMENTAL, INC- CAD963852Zn <br />7, TrelupaMr 2 Campanr Name u.s. FPA ID NumOar <br />C Denmum FadI11y Name and See Address U. S. EPA ID NuMar <br />CROSBY AND OVERTON CAD02Bd09019 <br />1070 W, 17TH ST <br />LONG BEACH, CA 90e13 <br />Fact phone: 582.432-5445 <br />ga. <br />9b. U.S. DDT Dvao;4m 0nd e" POper ShlwrrV Nana, Hmwd C7ma, ID Number, <br />10. Cal <br />m <br />11. Tele) <br />12, Urn <br />13. Wasq Gwen <br />Na. <br />Type <br />HM <br />and PKUrq Group 0f W0) <br />0uun91y <br />WtNul. <br />to <br />X <br />I. Waste Flammable Llquld, N.O.S., (Water Wygamgrle), 3, U N1993, PGM <br />r—c) <br />DM <br />OQ <br />G <br />343 <br />0001 <br />Dols <br />50 <br />G] <br />. <br />IOU <br />2_ Non -RC RA Hwrdoua Wast P. P.E Debris WMrace GasoaM),s <br />DM <br />1 /,/ <br />P <br />352 <br />4. <br />141 Specl.1 Hand6rq lneauutlune and Additlmal lydurm.11 m <br />9bl) Profile / 64786 UE Job 6 4100 . <br />902) Pro111e A 04701 <br />Wear Proper P.P.E. When HandOng <br />15. 0ENERATOR`SJOFFEROW6 COUIFICATION: Ilrombydedare Pie the m%erm Atllb=Nnrmnt am bay 00 emneey desglbed ebo by he pmWAIPPing nems, ud ere doolfled. 00tk ed. <br />marbled end lebeledrpar rded, and are In a0 metes N paler omdbm for "report @=Ing 4 applicable InWulio"And neaoral goVern ental reguladora. If amml shlprrenl mal I am No Nmery <br />Egcotor, I wtly Nat the mmane of N4 mmlgnmenl mnimm 4 dm ism of 9m anchW EPAAcWwMdgment of Ca cal, <br />artey Net tle wmq minbntrfbtn.4amaM Nemm4a In bCFR 2d2.21(a) (M l am a lerye awntlb tmnemmrl m (b) 011 em a em pwndydenmM h true <br />Mmn Da <br />Genmbr nPnnlad/tyryQ Your <br />TY'. <br />Wesl <br />Jvja <br />I . bm an cab ' <br />❑Impvlb U.9. Expert ftU.S. Pa1�erNyledO <br />TranspoMor viNMre(for esporte oNy): Date lavtq U.S.: <br />IT TWdp44rAdMIad<alanl of MaM94 <br />TZ-wpgrarl ntedffypedN Signature Mont Day Ye9LLµ&[ <br />�V <br />megaJa f n saveMonty <br />our Your <br />+ <br />1e. Olaeepanq <br />196. Db pacy lndloolon Spm ❑ 0 e.th ❑ Type ❑ Rmkw O Pargal P.J.-H. ❑ Ind Rej.Woo <br />Men9ml Reference Number. <br />y <br />16b. A wren Fedlny (ar Gammie) U.S. EPA ID Numaer <br />rW <br />ear. <br />FadOya Prare: <br />td6 SpruWn ofAlanle4 Pooility(V GNtTor) Monty Day Yam <br />19. MIZIN W M516 PJW My 90111enl WNOd C0003 O.e., 00003 W NaMA%not4 beeaneR do", and focyaong "All) <br />a{ <br />20.Oempubid Fadly C"or or Opera r.. Cerdeoallmo mawailcamm lye" <br />n ypep Nartm W9 aeaW y <br />NiA <br />EPA Form 8700-22 (Rev 3-05) Provlaua editions WAiMple. <br />10323.1161 <br />DESIGNA D FACIL TO DESTINATION STATE (IF REQUIRED) <br />