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RIease print or type.(Form designed for use on elite(12-pitch)typowriter.) Form Approved.OMB No.2050.0039 <br /> UNIFORM HAZARDOUS S.Generator ID Number 2.Page 1 of 3.Emergency Response Pho a 4,Man stTrackin Number <br /> WASTE 11tAN)FEST OAIA00$85J17 �� -823-8772 !.�6 750 FL <br /> 5.Generag?s`Nama and 1a1@iingAddress Generator's SitoAdd[eas(dddferent than maili g address) <br /> t3NNEKSAL SVC RECYCLING A111 WlHiam Mendoncit <br /> 3200 S.EI Dorado Si. <br /> S ocHtotl,CA 95245 <br /> Genaraiofs Phoria: X535 <br /> Transporter6. y ams U.S.EPA ID Number <br /> Union Pacific Lines CO NEM01792910 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8,Des'gnated Faddy Nems and Sliav4oressl U.S,EPAID Number <br /> ECDC Env'sranmRnW UTC0*12201 <br /> 1114 Weg Highway 123 <br /> Facaty s Plwne 4451 <br /> East Carbon,Ur 84620 USA <br /> ga 9b.U.S.DDT DescrNon(Iruludng Proper SK-pping Naive;Hazard Class,ID Number,. 10,Containers it,Total 12.Unit 13.Waste Codas <br /> HM and Paddn0 Croup(ffsny)) No: Type Quantity MJVOI, <br /> ad X <br /> t. NON�RCRAH�t`�UaVUr`I�;SJI1L3'i�GirL'iG� regulated) 001EK; t?��� 51t <br /> ul <br /> W <br /> 2 <br /> 4. . <br /> 14.Special Handsng InsWc0ons aMAddYdonalinforma0on <br /> LiWERSAL SERVICE RECYCLING PROMCT <br /> RAILCAR NfS. <br /> Nafi RCRA Sindder Rteldue <br /> ECOG Profge#4441 i5 84t?3 <br /> 15, GENERATOW&ADFFEROR`S CERTIFICATION:I hereby declare that the contents of this consignment are fully and accuraWy described above by"the proper s4pfng name,and are classified,packaged <br /> marbed and tatta(ed Acardad;and are in all respells in proper condition for transport accarding to applicaW International and national govemmeniat regula0ons.it export shipment and I am the Primary <br /> Exporter,108"that the contents of Ods consignment conform to the terms of the attached EPAAtdmWedgment of Consea <br /> I cadify that the waste minimization statement Identified In 40 CFR 262.27(x)(f I am a large quantity generator)or(b)(N am a small quantity generator)Is(rub. <br /> crams me ne <br /> Month <br /> [Day ear <br /> _r 16.International Shiluaents <br /> p ❑Import to U.S. ❑Expod from U.S, Pod of enhyl <br /> Z Tre r ' lure for only): Date I r > <br /> W 17.TranspotAnadsctgmemlofRecetotMatartas <br /> a Transporter 1 Printu fyped Nam Signalum Morin Day Year <br /> ��� <br /> ir✓l� al1 I 13 rayl <br /> Transporter 2 PrintedfTypad Name Signature ay ear <br /> 18,Discrepancy <br /> 18a.Oisuepancy Id&atmn Space ❑Ouanthy ❑Type ❑Residua ❑Pa W1 Rejaeton ❑Full Rejection <br /> Manifest Referenca Number. <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> Faaa s Phone: <br /> 16c S6gnahaa of Alternate Facility(or Generator) Month Day Year <br /> 19:Hezardoue Waste Repod Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 3 4 <br /> 20.Designated Facility Owner or Operator:Getricellon of receipt of hazardous maters covert by the manifest except as noted ih Item 18a <br /> ntedtTyred Name Signature month 1 <br /> EPA Form 8700.22(Rev.3-05) previous editions are obsolete. DESIGNATED F VYIO GENERATOR STATE-(IF REQUIRED) <br />