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' ea' uss on elite(12-pitch)' c FomlApprovsdr.OM6 No,205W39 <br /> Please print or type: Form d {yned for. typewrite ) <br /> UNIFORM HAZARDOUS i;Generator ID Number 2.Pegs 1 of 3:EmofMcy Rssponee Phare 4:ldanifa Ft r <br /> WACALOMM717 , . <br /> 5.: ensrstore.Name a GSMMWB SMAMMS I Ulan mal-1150 MSs <br /> U-ASAL SVG R `fG ' Ain WWw Wadma <br /> a 'El Dotwo St, <br /> Slooklon,CA 2M <br /> Generator's Phone: <br /> ransportar ny Ram <br /> U,S:EPA tD Numbsr <br /> CC) <br /> 7"Transportar: Company Name U,S;EPA ID Number <br /> 8.nlgnatadl Facilliy U.S.EPAtDNumber <br /> ECDC'Elwbronplonlial UTODM12201 <br /> Ilii st HVwaU 123 <br /> Facility's P 4 1 <br /> 9a. ' 9b•U.S.DOT Description(including Proper ShlppEog Nam,Hazard Claw,ID Number, to.Contatnars 11::10181 12.Unh 13:Waste Codes <br /> HM and Pa&M Group(d any)) No. Type OuBnt>ty WUVOI.`. <br /> 1.. <br /> 4-R ^r WASTE, I. CfT c ''. } 1 i 5 g <br /> 2.tu <br /> i <br /> i <br /> 3: . t <br /> 4. <br /> l <br /> 14 SOWW,Handitrlg lm trucbonssiidAddiU"'I <br /> UMWSAL ,Y <br /> f irk <br /> 15, GENERATOR'S!OFFEROR'BCIDiTi6UTION: lhetairidedaretttatthe;u>MsittaatU�s r mentatakdiy dasc�ibedo wve?1WtltePmpetsh rnersdd�re' <br /> marked and labaledrpl-Idol,;and are In all reap"in Proper condidwlort(arlsp0rl saorti to krtsrrt�iorietand naUonel H.eXport zta{ar�ttrsnd tarn tfte Pdraaay <br /> Expodar,I cardfy that the cont".01I ft MmOmerd woorm W tha term of the attact EPAAdmoKdadgmsntof COamnt <br /> I car*Ural thswasta minimization statement ldan#W In40,CFR 2622T(e}Cd,l am�}erge quantity psttermtar}or(b)(rf l am.a smelt quanti4t.ganeretor)ls true. <br /> eras ,. , y ser <br /> 107 x <br /> r�7 <br /> t6:InternaUaral nus L l Import to U.S, �Enport fran U.5. Port ofanhylwdb <br /> z Transportersliphrm,for expoirls only): Data U.S.:. <br /> 17r Tranapor(ar Acknow edgment o1 Rapt of,hlatarta}s <br /> wonm usy year <br /> IIS' 07 .. � .. <br /> renaportar rinlidl&aNanm <br /> w. <br /> 18:-Discrsp racy <br /> 188.DiscreParacy indication Spaos El Quantity EJTY,. 0 Res68 ❑Pett ai L J Fadi <br /> Meru Retmoce Number. <br /> 18bAlamate Facility(or Generetor} U,S.;EPkVNumlw <br /> .:a l <br /> t�! <br /> Facil s Phone: <br /> 18c:Soatu'reofAtemateFaddy:(org;m-N) th Y Y , <br /> 19.Hazardous blasts Rapaf Maneganssnf Mau d Codas(e.;da3ai�r,haiardau waste tnsalmsnt,;dispoeai,and rsc04, } <br /> 2 5. 4. <br /> 2U.Osslgnaiad acHliy r or 0-paralor.CerU6eatbn of rec*of hazardous materials Covered by the m8nifsstexceptaanb 'ln qem 168 <br /> Pr ntedlTypad Name th Y- Ynr <br /> EPA Form E700-22(Rev.3-05):PreAoUs edittaas are obsolete. ` DESIGNATED'FACII:ITY MGENERATOR <br />