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:print or type.(Form.desi ned for use on elite(12-pitch)typewriter.) Form Approved.OMB No,2050.0039 9'UNIFORM HAZARDOUS 1.Generator iD Number 2.Page t of 3.Eme R nsa Phone 4 Manifest TraftHumber WASW MANIFEST31934, FLE 5.Generators Name and Ma€Nng Address �NG fT t fl�tri Walton" Site Address Cd different then ma;Tirg address) eRSAL SVC320c,S.H Dorado st aevton,CP; 95206 Generators Phone: ` 6.Transporter 1 CoipawqyN—am U.S.EPAID Number umn Paahc Lines CO3 7.Transporter 2 Company Name U.S.EPA ID Number 6.1)asi naiad Facility Name and Site Address U.S.EPA ID Number fi-CMIC. 'ITC69 i 111 1 !-t HighvW i 23 a� Faal'fry's Rhone: E 44A• 1 t"..a T41,UT 945211 USA � .. _.._ ga, 9b.U.S.DOT Description(Including Proper Shipping Name,Hazard Class,10 Number, 10.Cofitein rs 44.Total 12,Unit 43.Waste Codes HM and Pacidng Group(d any)) Na, Type Quant ty M./m, � 1•a. n aSSCUD F r:� f 611 4. 14.Special Handling instnrctlons and Additional information UrWeRSAL SWXE K-CYGUNG R w > s .� �2 G Sae ?GRA 9 oar es1c ECC}C F tt4T i 16 84M 15. GENERATOWStOFFEROR'S CERTIFICATION: I hereby dire that the contents of this consignment are fully and ataursta3y described above by the proper shipping name,and are classified,packaged, marked and tabeladlplacardad,and are In all respects in proper condition for transport according to applicable International and national governmental regulations,if export shipment and I am the Primary Exporter,I certify that the contents of this consignment conform to the terns of the attached EPAAdnWedgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a)(If t am a large quantity generator)or(b)lift am a small quantity generator)is 1iue.. Genera a era's •n yped Name Slijriatum ME Day ear .r 16.International Shipments � ❑impart to U,S: ❑Export from U.S. Pott of enlrylexd: Tran rter 'nature fora only): Dath Isayhy U.§ tY 17.TmnspcderAduowL*rnsntofReceiptofMaterials Transparrer l- dniedrfyped Nama" 7 '- yY a ar ar Transporter PrintedlTyped Name gnaturamonth Uq at 48.Discrepancy __.r_ -, 16a.Discrepancy Indication Space ❑ Quantity, r'l7ype 0 Residoe 0 P.dialRejection ❑Full ReiecBor Manlfas4 Refamm Ndmbec,....,. 18b.Alternate Faddy(or Generator) U.S EPAID Number J C�. Facet s Phone: �'18e,Signature of Alternate Facility(or Generator} Month Day Year 19,Hazardous Waste Report Management MetLod Codes(i.e.,codes far,nazardovs•ti a traabMat,disposal;and iac)TIir l.systems} 4 20.Designated Fadil,y Owner or Operator:Certification of moeV of hazardeas maliftodvared by the maigf5st a as noted to ftasn lBa , not yPed Name Signature Month Day ; Year r _ 9" 1EPA Form 6700-22(Rev.3.05) Previous edition are obsolete. DESIGNATED FACILIT;Y TO GENERATOR