Laserfiche WebLink
Please print or type.(Forth designed for use on elite(12-pi"`)fypewniterl, , Y� Fort roved:OMB No.2050.0039 <br /> UNIFORM-HAZARDOUS t.Genarebr ID Ntm>bor 2.Page t of 3.5rwrgerwy Response Phone d.Mani ram umbo <br /> WASTE MANIFEST, CAL OOOSWI1 i 1 415.823-877 <br /> S. tort Generators Sila AWmss(10 ffmml than m0ng a <br /> U�iNIVERSIAL S,.t�C.{F��GyY'ONG,Ala WHam MendMig x <br /> �O�aa�yyL,�W)�}S,El CA <br /> St - P <br /> 31V��R1on.CA t <br /> Denerakx's Phow <br /> .Vansporw 1 Companywarne U.S.EPA P Number <br /> Union Paeft Lines CO NEDMI 7=1. <br /> 7.TrBnspoft 2 Company Nam U.S.EPA ID Number <br /> IE DasV�Fadgly Naffim—arifftress U.S.EPA ID Number <br /> I 111 bah k Hitshway 123, <br /> Fera Phone: Ca <br /> 4453 I~ast rbon,LIT 846620 i. 1 <br /> ga. 9b.U.S.DOT DesaWon Qndudeg PmW SNpp rg,Naft,Hazard Class,10 NwAw, 10,Gontsftuas ti.Tmal 12 Unfit 13.Waste Codas . <br /> HM and Pig Grin(Many)) No. Type 0tmtity ' Wt Nd. <br /> 1' 611 NON-#CRA HAZARDOW WASTE,SOLD(Non-DOT regutated) 001 Ho Y <br /> LLJ <br /> 2. <br />€ � <br /> r <br /> I <br /> 3. <br /> 4. <br /> id.Spadai Flarkllifg YtshuC6ona endAddrlional intarmatiae <br /> UI�4 VERM SL F m FECYCU14G PRORCT RAILCAP NO. <br /> fdon*CkAi swedoir Rte vj <br /> ECDC Pra61.1;�#�61 i� <br /> 15. GENERATOR OFFER0h'S CERTIFICA,jlt, hereby dsdam that the contents of 8tis consignment are hAy and accurately desabod abode by the wow sNppng rt ,atdam dassiFed,packaged, .. <br /> marked and WWWffifecatdid,and are k prop�r condit for hnsW acp ng to aWicable hternatknal and naftW governmental ragulaftm,if export sNpmanf and I am the Prower' <br /> Exporter,I ou*ittat the eorrbsnb of dots norm to ft term of the att dike PAAcknaxtadgmait of Consart. <br /> I csitfPy itmt the waa8a midrt trailon alatans i tdanttrrad ri 40 CFR 26227(x)(ff 1 srngthw quaray genaralor)or(b Af I am a small gt>�ty generator)N true. <br /> ear <br /> )L JS fs <br /> —1 18.Warns arat Shipments ' <br /> ❑Impat to U.S. Export from U.S. Port of enbyt <br /> ITra for Data bow <br /> � 17.Tra�apod•°r a�to(RacdptofMalar� �';,� .:•:.r :, <br /> Trtavorter i ypal s t na u a r„Y.;;a A y Y687 <br /> a. <br /> TranspxW 2 RrAWyped Raim Signature <br /> t� <br /> 16.Dscrepwq <br /> 16x.D saepancy inolco86t 5paco. Q 0uandty ❑Ty" ❑Red. ❑Partial Re}adion ❑F-A <br /> Marsfast Reference Numb r. <br /> 18L.Attarnxb Fad ty(or Oatiera4 U.S.EPA ID Number <br /> v <br /> ti Facdi s Phnna: <br /> 180: of to F a motor) Month Day year, <br /> 19.Hazardous Waste Report Management Medrol Codas p.s.,codes for hazardous wtats haalrneri4 disposal,and raeycang gowns) <br /> 20.Desgnaledr Fedrity One or 0"M Ce�of rar*of hazardam materials covered by the mxftt axcapt as row in fbrn 18a <br /> Pnnieffypod Namsr j are *., Month y <br /> EPA Fomt 8700.22(Rev.3-05)Previous editions are obsolete. DESIGNATED FACILITY TO GENERATOR <br />