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" ` Please print or type.(Form designed fdr use on alite(12-pitch)typewriter.) Form Approved.OMB No.2050.0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone„ 14.Marift1stTracki, Number WASTE MANIMT CAI_ d5571700906739 FLE 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) I_tNVERSAL S;dC RE YCUNG A,f+7lWfillm trMenduf1Ca 32M S EI Dorado St St�ctcT,CA, OM Generators Phone: 6.Transporter 1 Company Name U.S.EPA ID Number UIQ Pacto Lines CO tE=i m 7.Transporter 2 Company Name U.S.EPA ID Number 8,Designated Facility Name and Site Address U.S.EPA ID Number CDC EmilmnmMtal UTC093092 1 119f w 123 Facility's Phone. 1 UaST,?.rbon.lJ 445210 USA ga 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11•Total 12.Unit 13,Waste Codes HM and Packing Group(if any)) No, Type Quantity WtNol. j t 0Lu 6'd�.lt�8-tX�S"5-41 C1 t,i'.J6�x"3 VYi4�i�, a(iYiJd h'Wt»pt F •13,1 ....... r... .__�.�3 .,. ..... -..'P... ..,..,,-..-,:.__:"''_. E i 4. 14.Spacial Handling Instructions and Additional Information J(� RAL E R CY PR RAILG . 15. GENERATOR'SIOFFEROR'S CERTIFICATION; I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, marked and labeteftlacarded,and are in all respects in proper condition for transport according to applicable International and national governmental regulations.If export shipment and i em thio Pdmary Exporter,I codify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of C sent. I codify that the waste minimization statement identified in 40 CFR 282.27(a)(If i am a large quantity generator)or I amj small quantity generator)is tare, Gan 1 toes do came gnature on ay ear —+ 16,International Shipments F— ❑import to U.S. ❑Export from U.S. Port of entrylexit: Transporter signature(for ex ds only): Date leav U'S.: OL: 17.TransporterAdimc;wedgmentofRecefptofMaterials h.»•. ., .. ..,�.,, _. r— nature ay Year, Transpodar i PrintediTyped Norma 44 Z Transpodar 2 PrintadrTyped Name Signature Month Day Year rY Ea 18.Dlscrepauy 18a,Discrepancy Indcal on Space ❑ Quantity ❑Typa ❑Residue ❑Partial Relectian ❑Full Refection Manifest Reference Number. IW Alternate Fadllty(or Generator) U.S.EPA ID Number to , LL Facili+s Phone: w 18c.Signature ofAlternale Facility(or Generator) Month Day Year d S19,Hazardous Waste Report Marrogoq ent Method Codes{cel,codes for hazardous wasto treatment,disposal,and recycling systems) 3. 4. 20.Designated Facility Omar or Operator.Codification of receipt of hazardous materials covered by this manifest exceptas noted in Item 18a Rintedlrypod Name { Sgdature t _ EFA Form 8700.22(Rev.3.05) Previous editions are obsolete. DESIGNATED FACILITY TO GENERATOR