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} <br /> Please print or type.(Form designed for use on elite(12-pitch) liter.) Form Approved.OMB No.205a-0039UNIFORM HAZARDOUS 1 ID Number 2 Page 1 of 3.Emergency Response Phone 4.Mantfest Traekin Number <br /> WASTE MANIFEST Cw:0003567•17 1 41M2M772 ®0 010 6741 1 <br /> 5.C,enerebr s Norma and Na rsg Addmsa Gerimloes Site Address Of different than mamng address) <br /> UNNT=R9AL SVC RECYCUNG Ain Wililam talendonca <br /> 320a S.El Dorado St. <br /> Stocklan,CA 95355 <br /> Ganerators Phone: 209.944.955a` <br /> 6. ranspo or w—ony Nam <br /> U.S.EPA ID Number <br /> Union Pao&Lines CO <br /> {�IEQ00170291 U <br /> ].Transpader 2 Company Name U.&EPA ID Number <br /> B. <br /> Daslpatedl-Raxlffiq Name sod M Addrws ECU.S.EPA 10 Number <br /> LfC Environmental t�T+s�t�:30'122�•i <br /> 1111 West Hiohwav 123 <br /> F,91 e,Phone: -444'4451 East Carbon,UT >.Ss 520 USA <br /> ga. 9b.U.S.DOT Desaiplion((nduding Proper Shipping Neme,Hazard Class,to Number, f o.Conlainers <br /> HM and Pacidng Group t8 any)) 11.Total i2.Unit Q.Waste Cases <br /> No. Type Quantey "Wol, <br /> f. ry <br /> o ili�iv- ircN 'r+c'r°SRDWS VVAO I c,aui_iD�avGzruv i ieguidieuj "�° Flu r <br /> I 611 <br /> H <br /> $c 3 __ .._._.__�.. _._. <br /> Z 2 <br /> Uj <br /> f <br /> E <br /> t <br /> 3. <br /> 4. <br /> i <br /> 14.Special Handrmg Instruetfons and Additional Informatlar t <br /> UNIVERSAL SERVICE RECYCLING PROJECT RAILCAR NO, <br /> CRA Shredder Residua <br /> ECDC <br /> ECIIC Pronla#l:4041 15 8405 ! <br /> 15. GENERATOR'StOFFEROR'S CERTIFICATION:I hereby declare that the contents of this consignment are fully and aoarreteiy described above by the proper shipping name,and are dassified,ped(aged, <br /> marked and labeledtpiacarded,and are In ell m4pects M proper caMMlon for transport e000nRng to appkabls Intamarionel and naWai governmental regulations.If export shipment and!am the I(anary <br /> Exporter,I certify that the contents of this consignment conform to the temp of the attached EPAAduwMadgmant of Consord. <br /> I partly that the waste rdnlmfzation statement Identified In 40 CFR 26227(a)Of I am a large quantity generator)or(b)Of I am a smar tlty generator)Is true, <br /> PdriOTOB Nam Signalize <br /> Month ay YW <br /> �..i 16.kdamatlahalS me —� <br /> ❑import bo U.S. L r-_l Export from U.S. Pod of entry/exit: <br /> Transporter signature fbr exports only): Date wria U.S.: -- <br /> 17.TrdhsporierAdirhoa48d9ment of Recoolpt of Matark" <br /> 12 Transporter t typed Name th ay Year <br /> 4 tete <br /> i Transpo ter 2 P ntedJlyped Name nature ' <br /> Month Day Year <br /> to,0istxepancy <br /> i <br /> iea.Dhaeparwy IndIcatlon Space ® Quan6y ❑Type Ej Redd. ❑Partial Re)eCuon ❑Full Reiection <br /> tAarrifast R�eranc�e Nrm�er. <br /> leb.Ailemete Facility(or Generetor) U.S.EPA ID Number <br /> LaaltVs Phone: <br /> tec.Signature ofAltemate Facility(or Ganeratw) Month Day Yeor <br /> 19.Hazardous Wap Repod Managamsnf Method Codes(I.e.,codes for hazardous waste treatment,dlsposel,and raiyding systems) <br /> 1• 2 3. 4. <br /> 20.Designator!Fady Owner or Operator.Cadifl aNan of receipt ofhazardow matadals oovered by ft manifest except as noted lin,Item lea <br /> ftWyped Name Signatura�, Month Da ear <br /> EPA Form 8700.22(Rev.3-05)Previous editions are obsolete. DESIG D FACILITY TO DESTINATION STATE OF REQUIRED) <br /> i <br /> i', <br />