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i <br /> Please print or type.(Form designed for use on elite(12-pdch)typewriter.) Form Approved.OMB No.205HO39 <br /> UNIFORM HAZARDOUS 1,Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Mafufast Trading Number <br /> WASTEMANIFEST C 1 717 1 #95 32 772 <br /> S. enarato;'s•Name and Mailing Addw GenciraWs Site Address(B ditmnt then mailing address) <br /> UNNERSAL TX RECYWW Alp WMam menalwa <br /> 32co 5.a borado st. <br /> StOWN, <br /> Generator's Phare: <br /> ransprxtarnyRa-me U.S.EPA ID Number <br /> Won Pacft Lk*q Co <br /> T.Transporter 2 Company Norma U.S.EPA ID Number <br /> 8,Destgna Faairty Name and Site Address U.S.EPA ID Number <br /> Il1,11 West 123 <br /> FaclHty,Phw s1, E891 Clubm,UT 8020 UM <br /> ga. 9b.U,S.DOT Dast iption(Including Proper Shipping Name,Hazard Class,ID Number, 10.Containers ti.Total 12.Unit 13.Wasta'Cades <br /> HM and Packing Group(tfany)) No., Typa Quantity WtAV. <br /> 1. <br /> D,iY't9d Yid' b!i&^f6Y`IYt Pts d� <br /> Ms <br /> P°O 7"F(t Y�wr i �) ( 1 <br /> a raa+ rs �� t /S <br /> z 2 <br /> w <br /> c� <br /> 3. <br /> 4. <br /> 14.Spedal Handling Insh6ons and Additional Information' <br /> LWVERSAL SERkne RErV0LWQ:pRQfflCT <br /> 15, GENERATOR'SIOFFEROR`S C ATION I h6rdb dedsre Eig{tho axtrits of this consignment are fully and accurately described above by the proper shipping rmeme,and are dasslIM,packaged, <br /> marked and Iabeladtplaearded and'am in all respells in propat car 6o ffor transport according to app ic"irdamadonai and national govemmantaI regulalkms.If export sill <br /> pmant and i am the pr wary <br /> Exporter,I certlf t the MAlents of ttds consignment conform td lila la ms of the attached EPAAekrxnvledgmant of Consent <br /> 1 csrtify that the, as_to mlflhl ori -#tq=nt fdetmtf w in 40 CFR 2V27(a)(e I am a large quantity generator)or(b)(d i am a small quantity generator)is tma, <br /> Uenerawswriews HMOyped Name7r-rgna urs Month Day Va—Br <br /> i r f ' <br /> .r 15.International Shipmools' <br /> D tt- 11 <br /> Import to U.S. ❑F-xpori from U.S. Port of entry/ea <br /> Transporter signature foie` only): pate tea'N U.S.: <br /> m i <br /> 17Jhm90oIarAdmq#@dqmert Ppoe <br /> --Typed rre Transporter 1 nn ob <br /> aY: . ear. <br /> Vendws <br /> I 2 Transporter 2 Printed/typed Name <br /> u"ture Month Day Year <br /> E <br /> 18.D*crepancy <br /> 18a.Discrepancy Indication Space ❑ Ny ❑Type ❑Fies[due ❑Partial Rajacdon ❑Full Re}ecdon <br /> A#vilfast Referenm Number: <br /> I Bb.AHamate Fedlily(or Generator) U.S.EPA ID Number <br /> J <br /> IUv <br /> F '• s Phone: <br /> :18c.S gnature ofAfEemato Faal ty(or Gersarata Month Day Year <br /> S2 19.Hazardous Waste Report Management lhathad Codes(I.e.,codes for t zr+rda>s waste treatment,disposd,oro--yefing syst—) <br /> 4 <br /> 20.Dssk�nated FaaHry Owner or Gpsrator of racelfrt of hmatbas materials izvered by dta maofifest except as noted in halo 18a <br /> PnntedlTyped Nana SignatureMgftpay Year <br /> EPA Form 8700-22(Rev,3-05T Previous edIi8ona are obsolete l <br /> D SIGNATED FACILITY TO GENERATOR <br />