Laserfiche WebLink
Kul <br /> Please print or type.(Form designed for use on elite(12-p1NNf»)iypevrrftei FormApproved.OMB No.2050.0039 <br /> UNIFORM HAZARDOUS 1.Genamr ID Number 2 Page,1 bf 3.Ertargancy Respatse Ptane 4•Man t radd N[u'm�bar r� <br /> WASTE MANIFEST CALOXI 5747 445-823-sT7a r�! ? L <br /> 5. Noma rnd Malthg Add ess s roes Of am ntow mdng address <br /> 1JNlV ftSAL SVC WYCIJNO41n Will=Mamma <br /> 32M S-E!Doradd St, <br /> Stooktorr,CA SM <br /> ow*mtots Plwna: 5S <br /> 6. renspoder I Corrpny Wnje U.S.EPA tD Nu r <br /> Union Pacific Lims CO, # <br /> T T 2 Company NBme U.S.EPA ID tdtanber <br /> DFSFgnotBil-F Nw%and Sits Addrea U.S.EPA IDNumbe " <br /> ECDC 61vfifOtTti ental UTC 3C##2?R# <br /> #iii West H , <br /> 123 <br /> Fadtil}+a tom. <br /> 4 1 East CM bm.Uf-''046217 USA <br /> 48. 96,U.S.DOT D-1ption Cs Proper Shipping Name,Hazaid,csa,ID umber, 10.Conta}nersf 1.ToSal 12.Unit 13.Waste Codas <br /> HM and Ped trtg Group WO) 4411qtc�r- No, Type Qmtty WLAV, <br /> 1 f`'�J{� RC A�a s a•snU US WASTE,Srem�(Wri-3i T i—vgUl;�-') w, <br /> x. <br /> 3, <br /> 4. <br /> 14.Spa3dl Mstrudiomand.Addibonallydonnation <br /> gl�tf}+NpV®I~$P�S�ftiQyl���lj�glp(CE RRC'YiCUPIt^,m.1= RP.I,CAR NO. <br /> 'i14M11'(16i7jI'I.ylllYYi{Kl Re6Mtd8 ' , } <br /> C[tC:iSiDti{ tdQ4i i6 84tf <br /> 15. G95d TOTP9(OFMOR'$CERTmAEON:I hereby de dam that the mounts offt ern Vnent are My and aavrately daaatbad above by tits proper shipping nems,and ate 8assfiad,psftgbd, <br /> merW and fa and are In d respacds In proper ctxt bon for ACCOWN to applicable into neftwl and nagoml govemmontel regulations.It wqw sNpmmt and i am to Primary . <br /> Exporter,106i*that Me emWb of thb=Wgmmt earform b Ute tams of bte"EPAA*aw+ladgmem of Consent. <br /> I cWfy that the waste Mian stat®naM lden#W in 40 CFR 28227(a)(If I am a tatye7juantlry penerator)or (N I am a Inn Quentlty ganaraa)is true, <br /> a ams Yeaarr <br /> f <br /> 18,Intematlamt Shtpitants ❑Import to U S <br /> Fxpott from U.S. .- . Pmt of enityfext�t <br /> z T s lure for f': Date leavlUM'M?M:M lju '.. <br /> w 17.TtBnspa arAduwa of pmaiptof hlatstiE<s <br /> a tar porta 11Prin yped Name <br /> Month y : ear <br /> Tri-n4aw2ft1tedIlypedNarne alum <br /> .r <br /> 18.Distzapaniy _ <br /> 18a:O'rscmpanoy Space ® uty ❑Type ❑R.W. ❑Parf.i Rejection L_t Fuii RejecdW <br /> . tkantesE tieferenco Namur. <br /> f 8b.NWnsta Fecft(a Generatco US.EPA ID Nunber <br /> ci <br /> W <br /> FacRA Ptxxte: <br /> tec re orAliemate Fack(a Generawo <br /> ' Month Day Year <br /> Q <br /> z . <br /> 19.Haurdow Vbsb Report lvlanegenwA Meow Codes CLO.,c fa ttaaardats wash traaamnt,des mat,and reW*V systems) <br /> 1 �A\ !D <br /> 20,Dasigh&W Facility Owner or Operates;Irl of receipt of Faz u4mA rmiarlab wmmd by Uta rrardlest WWI as noted in Item 18a <br /> Pn t9 *,f�'} mmm Day Year <br /> EPA Form 6700-22(Rev,305) Previous editions are obsolete: DESIPsNATED FACILITY Td CENERATt1R <br />