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Please print or typo.(Form designed for use on elite(12•pR6)MwAter.) Y (�Form <br /> (Approved.OMB No.2450 0039 <br /> UNIFORM HAZARDOUS 1' f7717 2 P 1 of 34Ln&esamse Bone 4.Man®® N w'1 G <br /> W MMIFEST if!r� <br /> s. arks AWMERM SVC RECYCUNG AM William Mendn a Site Mdrow Of dIfferent than ) <br /> 82(313 S.El Dorado St., <br /> MUM,CA SM <br /> 2 <br /> Generates tom: <br /> r'�r'v orw mon Paofic Uses CO u.s.EPAtDNumtsar <br /> NEDOtH 7929 i 0 <br /> 7.Trigparter 2 U.S.EPA 10 Number <br /> DC Etwironmental U.S.EPA to Number M, p4un b 2'C1 <br /> 1111 West Highway 123 <br /> 1 East Carbon,LIT 84521)USA <br /> Fa Phone: <br /> ga. 9b.U.S.OOT Dauipkn NdwjjV Proper shpjft Name,Hard Clan,10 Number, 10.coffwrtere 11.TOW 12.Lwt 13.waste Codes <br /> HM w-d 8 tdany)) No, Type Quantity wuvoI, <br /> t"NMRCRA HAZARDOUS WASTE,SOLID(Non-DOT regulat4 001 HO � ! T 511 <br /> ® t <br /> a � <br /> 2. <br /> LU <br /> 14.9pM InslcucYrorn and AMwal WdMMa60n <br /> UIdNERSAL SERVICE RECYCLING PROJECT <br /> RAILCAR NO, <br /> Noft•RCRA Shredder Residue; <br /> ECEPCPiOAletfdOd1168dD5 x Mol? <br /> i5. GENF.RATOR'81OFFEROR'8 nERnFiCATfON:i ttaeby aedane that the rant of dds caaipurlant sre tiny and mcuraEalyt shove by fha praq� trema,end era <br /> merited ,and mo In In Row cordtlon turWood ecwft to q#lcade tntamaEonal and natlarel gamnental aeplellons.If e*od st0nent and I am the PMMY <br /> Exporter,t Y tlta4Hn oatt�sta dtn� oonfixnt fa the of tlts attedtsd FPA of Coriasttt. <br /> I that the statement Menttfiea In 40 CFR 262.27(s)of I am a Fuge 4UMy generetar)or(b)Of I am a qd WIRY Qfflersb4 Is two, <br /> y eer <br /> 16.kt4amatbrtel mpments ®Impat b U.S. ❑Expat ken U.S. Pot of anwm.-dt <br /> T re Data lwft U.S,: <br /> IT,T ftw of ReoW of?&Web <br /> Transporter 2 Pft6dfryped Name to Monul UOY YM <br /> 16. <br /> Ift Dbnpmxy ktdbatIm Space ❑ ttty ❑Type El Resides ❑PmNI.,tion ❑Ful1 R <br /> ManNast <br /> Rokmim Nurse: <br /> 1Sb,Mlmnaie FacWy(or U.S.EPA III Number <br /> U <br /> w 16c Signaltaa�Adamata (ort?aatdjith Day Year <br /> z <br /> 99.F wmz ous Rets Report t Mal C Q.e.,codes for wase treslmW ,W rwjl*0 aydeme) <br /> 1. � 2. 3. 4. <br /> Zit,Dulgr4ad Fatty Omw or Opeator Cwffiwt�n of w*of haz>adon malwids wawl by Iha mit e=W as now In Ilan 1Sa <br /> Month Year <br /> EPA Form 87&22(Rev.3-45)Previous editions ere obsolete. DESIGNATED FACIMV01STINATION STATE(IF RBQUt ) <br />