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Please print or type.(Form das' ned for uce on elite(12-pitch) writer.) Farm Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS t-Ganara9dr ID Nwmbef 2.Page t of 3,Emerll wy Response Phone 4.tdanifest racks Numbe <br /> WASTE MANIFEST 141.ArID M717 t 1�i<R��c�77t ,� 676 L <br /> 5, a arawr s Name araMaSng Addmss aratoes Its Mdross iU Parent than maang address) <br /> UNivr-,,W A t(, a r b' IUNG `•R,r&"'att1 h nd(;sl<,3 <br /> QN)S,Irl Oorada 81 <br /> CA <br /> Ganeraws ftw AYIk4 i -rs <br /> o.TranspNW 9 LZMParri NaMe U.S.EPA IQ N xnDar <br /> u mar ral-;t:`iU Lain€C) r`e"nrirt4 0 <br /> 7..TraniFmer 2 C�npanyNama U.S.EPA 10 Nurnbet <br /> B,Nsignated Fad7ty Name ark Eta Address U,S.EPAID Numbar <br /> It <br /> it (J(s�`72Yi9'€"�f18a`1�Y}�vl <br /> Fags s P t-A t;.{, 1 ='1 t rrjris ti i b43d?�13'UF <br /> .`t <br /> ga. ct.U.S,DOT DosrxipsKart(Inck}rq Pieper ShO II Norma,Hazard Class,tQ Nuntbar, 10,Contatnars tt,TOW 12,Unit <br /> H&j aridParkvq Gru4(if any)) k a. Type Qua k* Yt AU 93.Warta Codas <br /> v ,i-F; F t�f ,` ?F r ,'IIS,S zi- (I!=ort" u'i 1(( � T r' <br /> w <br /> 2 <br /> 3. <br /> 11.Spacial Hand ng insinxbans and Addswnai In onnatan <br /> 4 / � <br /> ikI18 AL r r F is 'n-Gy,l,mG pri o'aT RAS XAR NO, LJ-5 (7 t <br /> 95 GENERATOR'SIDFFEROR'S CERTIFICATION:I herein declare that tM contents of M consiomrant are"and aauraiatydasubbed above by Ute prapar shiporq trema,and are dassefed. <br /> ma*M and labeled;pzcardW,and ata m as respects N proper omelidon far transport nowrdag to and"wriat gov mmental regulations.If export sHmmint and I am Use Prraary <br /> EzpoAer,I cem7y Utah Ura corrtents et flys WnsicnmON caniam#o Lha 9ern'3 of Ura a!tachad EPAAcicnottiadgmaM otConsent <br /> I cer*that the waste minor mticn staternant 1denVed m 40 CFR 25227(a)(d tam a large quantity generator)or(b){Y I am a was quantity generator)is we. <br /> nem ,e o?s i ypW Namay Year <br /> * <br /> n <br /> tu.lo'erna enat Kprrwts <br /> F-- ❑im�rt to U.S, ❑Exptut Fran U.S, Par1 of entrytezit <br /> 2 Transpd#er s' lura if3r owns ont S; Date lea" U.S <br /> 97 Transpc+lcrA.kra+��edgmPntalRecagta(Ata;e+iats <br /> 7ranspastar 1 PrntaCJTyped ama prior <br /> 2 Transponar 2 Prmtcd.TyW Name V tore ntti eat <br /> 96a DiscraFantY lndaaS an Spa El Quantity, C❑TgPe tJ Raskkw ❑Padiai Ra <br /> radion ❑Ful R®k'ctia9 <br /> Manifest Reference Nanbor. <br /> 9(b.Polem0 Fad!,ty(w G rant) U.S,EPA ID Nurnbor <br /> a <br /> v <br /> uUr t&„.5gpmura otArwate Facitly(or to) <br /> Month Day Year <br /> 99.Hazardous Waste Report Morgeawl Mathod Codes It a„codas to hazardous wasto t wvwd,disposer.ud racydag systems) <br /> Q t.. <br /> 4.Des ralad Fac+tty4Onner or Operator;CerGf'taL'orr of mmpi of hazardous nut M.IS tixcvered by tho manitast except as rwiad in ti m 1e3 <br /> PnrtetL?yped Norma ignatura U9 a r <br /> EPA Form 870022(Rev.3-05) Prey our editions are obsolete. DESIGNATED FACTi TO GENERATOR STATE(IF REQUIRED) <br /> E <br />