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Please print oc type.(Form designed for use on elite(12-pftch)typewriter,) Form Approved.OMB No.2P -Q+339 <br /> UNIFORM HAZARDOUS t.Generator ID Number 2.Page i of 3.Fnrergency Response Phare 4.hRanKa9 rac ing Number <br /> WASTE MANIFEST _ C�Al.OtT 3,55717 1 X15 82 37'72 <br /> 5.Generator's Name and Mailing Address Generators Site Address(if different than mailing address) <br /> 32M 1-1 El Olorado St, <br /> t�if�f��t��At 51V0 REOYGt �?!rt'Jv3ltlarrT t7danoa <br /> Stootoil,0�k <br /> Genarala's Phone: <br /> mnsporter 1 Mpany Names U.S.EPA ID Number <br /> I.;nion Parositc Lines CO , . t <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Fad q Name and Site Address U.S.EPA ID Number <br /> EnvirOnirnentgl (! f 3tli 2it� <br /> 111 i Aust I 123 <br /> FaaTrty's P . . , <br /> 44451 East Cwton,1,71 64526 USA <br /> ga, 9b,U,S,DOT Dasafptiat(including Proper Shfpping Name,Hazard Class,ID Number, 10.Contafners. it.Total 12,Unit 13.Waste Codes <br /> HM and Pecking Group(d any)} No. Jypa Quantity_ MCA. <br /> i <br /> 2. <br /> Uj <br /> s <br /> 4, <br /> F' <br /> 14.Special Handling instnafions and AddtiorsaI infoimatan' <br /> l.�a� 1R'kA.SERVICe RECYCLMPROJECT RAfLW NO, t J t ;K <br /> f�}ct� tri�i <br /> EGOC PwMW404i iS <br /> 15. GENERATBR'SIOFFEROR'S CERTIFICATION:I hereby dedara that the contents of this eor*ment'sr06l1y and aaxrralely described above by the praper shipping name,and are classified,packaged, <br /> marked and lalieledtplacamad,snd are in all respects in proper condition for transport according to appllcabEa and natrorral govammeniat regulations.,if export ship Want andlam the Primary <br /> Exporter,1,6r*that the,contents of thra consgnmeM confonn io the tem sof the attached EPAAdmarri t <br /> I certify;tl~iat the viasfa mJnhn za1 aka2aiemant xiantit}ed m 4l7 GFR 2t3227(a}Gf I am a large.quanbry ggnemEor )(ff 1 am a small quantity gana+@bsr}is Wes. <br /> ane a ar eras do ma XPr r on y ear <br /> t8:lntsmadonal Shipments <br /> F-• ;' ,k ❑Import to U.S. ❑Export from U.S. Port of entrp)exit <br /> Tres er ".nature for ex wt : Data lawng U.S.:. <br /> ,17,TranspoitarArt iwv+(edgment of t2eca pt of f latedcls <br /> Imo- Transported Pdn Signature ,,..ay Year <br /> NVI- <br /> BTransporter 2 Printeffyped Name' 8 " ` nature NMM TFa-y—ye—ar <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity []Type ❑Residue ❑Partial Re*tion ❑Full Rejection <br /> .Maridest Referenm Nombar:< <br /> 186.Alternate facility(or Generator) U.S.EPA ID Number <br /> r <br /> ±j <br /> u Fadi s Prions: <br /> w 18c.Signature of ARemate Facilfty(or Generates) Month Day Year <br /> S2 19.Hazardous Waste Report Management Method Codes(:a„codes for hazaidous vrasra treatinem disposal,and recy*6 aysiems} <br /> a <br /> 20.Designated Facility Owner or Operator Certfcat(on of t <br /> 't of haiardars marartals covered o'the ma ..` <br /> ecerp y p#asl eXcapt as rated in Item ltia � <br /> Printedtiyped Name _. . <br /> Ignature Ih y Y <br /> .. °`� 1 <br /> EPA Form 9700-22(Rev.3-05) Previous editions are obsolete. '2�DESIGNATED FACILITY TO GENERATOR <br />