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V <br /> Pease print or type.(Form designed for. on elite(12-pitch)typewriter.) Form Ap ved.OMB No,2050.00: <br /> UNIFORM HAZARDOUS 1.Geiiarafor 10 Number 2.Page 1 of 3.Emergency Response Phone 4.Manta Trwldnq umbar, <br /> q <br /> WASTE MANIFEST CALM03 r7T7 t 41 823 8772 1 <br /> 6.Generators Name and Mailing Address GleneraWs Site Address(11 dinsuent than malting address) <br /> UNKIERSAL WC RECYCUNG Ain WIMM hiendOMI <br /> M10 S I`f Dorado St, <br /> StoOton,CA <br /> GeneraWs Phone: 209-944-9555 1 <br /> 6.7-ranip-orter-PCornpany Name U.S.EPA ID Number <br /> Union Pacific.L€ries CO <br /> 7.Transporter 2Company Name' U.S.EPA ID.Number <br /> 8:Designated Facility Name and gileMatass U.S.EPA ID Number <br /> ECDC EfMrOnnx4*W UT IN <br /> t14$WestR 123 <br /> Facil' s Phe # <br /> East Carbon,UT 8452 l USA <br /> 9a. Sb.U.S.DOT Descr pborr(mc4xling Proper Shippirg Name,,Hazard Class,ID Number, 10:Containers ` "yt Total 12.Unit 13.Waste Codes <br /> HM and Padang Group(if any)) No: Type Quantity wtivol: <br /> / T..; v+ ar Le ert 'tist4-v` r'rt`if3ji. 4: { # may' I .7 ' <br /> w <br /> 2. <br /> t <br /> 3. <br /> 4 <br /> i 14:Speaal Handling Inatnict M and'Add'Nonal infomlafton <br /> UWIER19AL R'i *RECYGUMPROJECT RAILCAR W. G,.J-S- <br /> PrOW4041 16 <br /> 15. GENERATOR'SlQFFEROR'S CIStTIFICATIOH dfderetry tledare thatthe contents of tldisconsignment sre ftbly end arxurataly dascrtb9d above by the proper shlppGxl new,and are classtfiad,packaged, <br /> marked and labeladlplacarded,mxf ere p1 alE reapacism proper condfion to transport acoord3rrg to appbca at Dna!and national gine er mental regulations.if export sh pment ardl am khs:Prsnary <br /> i' Expater,l thatdhe cantenis of,tlnis ira�Rcprstorm tache tamu;of the atteclted EPA nt of Consent <br /> !c afy,that the waste mlmm€zatbn_siatarnegtiden in 40 CFR 26227(a}(tr I am alarge ggan-Yt er (b)gt f am a sa'a l quantity generator)Is true. <br /> s rM y <br />_ ,... n _ ear <br /> did' �tv� .� <br /> _t 16.International Shipments <br /> t- <br /> ElIm,�wrt to U.S. Export from U.S. Port of entry"04t <br /> Transporter r s nab re for ex only): Date leavingU.S,: <br /> 17.Trans nenlo(IR of Materials <br /> ra - Day <br /> Tear <br /> I Air <br /> tAt1fnt�Cti1 <br /> ZTransporter 2 PrintedtTyped Name gnature on ay ear <br /> W Discrepancy <br /> 18a.Discrepancy Indication Spat Quantity ❑Type ❑Residue ElFartia!Roj beh ❑Full Nedion <br /> Manifest Reference Number: <br /> 18b.Alternate Fad ty(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> . Fad' s Phone: _ <br /> 16c.Signature of Altehiate Faafity(or Generator) Mwtth Day Yea: <br /> 19,Hazardous Waste Repot Management Mettxid Coes(I;e, Tor hazardous waste treatment,disposal;and recycling systems) <br /> d 1. 2. 3. <br /> 4. <br /> 20.De4nated'Faah K3vmeror eieii*,Certrt�atlon:of raceyt(o{liazarrious materials covered,by the manifest except as noted In Item 18a <br /> PdntedfTyped Name � Signature / th P4 <br /> Y. <br /> EPA Form 8700.22(Rev.&05) Previous edr6oas are obsolete: "" <br /> DESIGNATED MCII.)Tl'To dEtaERA�rc <br />