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/Please print or type.(Form designed for use on elite(12-pitch)typewriter.) FormAApro.ved.OMB No.2050.0039 <br /> UNIFORM HAZARD®US. 1.'.Ponerator lD Nui rWf 2:Page t of 3,Emergency Response Pnone 4.MaotW racking Wmbar <br /> WASTE MANIFEST swAL 35571 1 415-E23 772 s <br /> 5.Generatoes Name and Malting Address <br /> eneratars SRO Address(rf different than mailing a dress) <br /> UNfVMSAL WCAMYGILING .Ain Wollwn Mendoma <br /> 32M S:EI OwWo St, <br /> Swollen,CA, <br /> Generator's Phona: <br /> ransportor I Company Name <br /> __.. ...... .., . _U:SrEPAfE?tJumbar <br /> Wion PSC f..1tl wCO <br /> T.Transporter 2 Co*any Name <br /> _ __._ _ U,S:EPAID'NdmW'hK <br /> K Designated PORama and Sita Addmss <br /> - U.S.EPA 16 Number ' <br /> COG Im71 <br /> $111 MstH 123 r <br /> ga, 9b.U.S.OOT DssPiption{including Proper Shipping Nama,Hazard Class,ID Number, 10 Cootatnera N.Total 12,Unit <br /> HAf and Packing Group(h arry)) t3.Waste Codas <br /> No. Type Quantity WWot. <br /> A.�DOT t` " ye t HG � all <br /> 1 <br /> i <br /> I. <br /> 4 <br /> i4.SpaclalHandlhrgirrshuctansandAddittagttnfamatidii ;, :__.,. ,-_ .., _ _ <br /> t ff �+ <br /> N RS<At VtM ICY PR� No, w S N�. 'r o , <br /> NOrl-ROM MOW R.. . <br /> ECOG 15MOW4U41 10 <br /> tS. GENERATOR SdOFFERtNYS G t <br /> ttetettr�3edare ltrsl tha conteri of this 6onsi .meat are fully a�id'ao&uetefy ifesated above 6y shlpph g nam and aro cisssl d, <br /> madwd and la 'placa ded and :in aN rospects;rn.protNr o3nddkxr fa-transpaA accareing to a kabla intemetbnal and national PmRe+ i <br /> Exporter,I t the owrten a€thcs oarrssgrrsnert em",to itis ferrbs of ftauached EPAAck aA*meM of Consent 9pvommenta!regulatlots.N export shipment and 1 am the Primary <br /> 1,carBty that <br /> vtaatw muupmtzataan t idertff5ad i.4Q CFR 282,87(e)fd I am a large quantity geaerato0 oc @){rf f am a smaN,quantity generator}fs tn�, <br /> Hera eras yPed erne +, .. ima r <br /> P&MIXY <br /> �r . <br /> , �•� fa z / <br /> F- ❑Import to U.S. ❑&pd tram U.S, Port of entryledt: <br /> Tr ' ature for its only): Date Mvim U.S.: <br /> il,jr?sporterAcl n meat of R of tAatariats <br /> _. <br /> r� <br /> 2' <br /> Transporter ar2iridtpeName <br /> momUayYear <br /> _ afore <br /> t- <br /> 18:Dlscreparwy <br /> i8a.Discxepancylncfcaaon Space Ouar�tY. TypeResidua a Partial Re}ecoon ❑FrAi Refon <br /> Mardest Reference Number: <br /> 18b,Aftemate F (or Generator) . _.-_. U.S.EPA ID Nuiibsr <br /> M <br /> +j <br /> u- Faa1i s Phone: <br /> 18c.S gnalure of Allemate Faa ity(or Ganaraiorj -- _ _..... _. td r Day Year <br /> 19:Haiardous Waste Report Min*nb i tAe#W Codes(i,e.,codes for tiazat3ars _IM rinent depose{and <br /> racyctin9systems} <br /> t <br /> 20,Des grated Faality Chvnar a Operator Celt nczsdan of race pt of 6azer<Yws ma+arr�s ai erad by the merest except as rrotest et Mm Ise <br /> fttedffyped Ramo <br /> Irth <br /> EPA Form 8700-22(Rev.3-05) Previous ediftdns are obs*W, <br /> DESIGNATED FACILITY.TQGENERATOR <br />