Laserfiche WebLink
96024 10 6 1346731 <br /> Please print or type.(Form designed for use on elite(12pitch)typewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2,Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST ,� � � 1 (aqq) 53s-5053 000037721 DAT <br /> 5.Generator's Name and Mailing Address Generators Site Address(a different than mailing address) <br /> Applied 4eraspace Structure Applied Aeraspace Structure <br /> }.0. ➢ax 6I85 3431 Sit. AIWORT VAY <br /> Generators Phone: Stockton 9 45286 121IM83-3339 STOCKTON CA 95286 (1119}933-3339 <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> 2Ast CentuCV Environmental (lana ement of California, LP CAR000210617 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number <br /> -JENERAL ENVIROWNfOL 116T, LLC 1154 PSC EAVIROAMENTi7L. SERVICES <br /> 13655 WITS ROCK ROW <br /> Facility's Phone; <br /> ga 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number 10.Containers 11.Total 12.Unit <br /> HM and Packing Group(if any}) 13.Waste Codes <br /> Na. Type Quantity Wt.Nol. <br /> 1. UN1169 WASTE CORROSIVE LIQUIDS, N.O.S. (SULFURIC ACID, A110 D102 D997 192 <br /> RQ DICHROMATE) 9 PGII L7 DF P <br /> rar _ <br /> LU 2. <br /> (1NIM IiiCORROSIV€ LIQUIYS, 4.0.S. (SUL_FURIC ACl➢, ALETON£) 6 1982 FBI] 791 <br /> X PGI.t DF 14'7 F' _ <br /> 3. tW1I75 PASTE FLUOROJORIC ACID (1982) 8 I6II <br /> RQ a DF P <br /> 4. UNIM PASTE CORROSIVE LIQUID, ACIIIIC, INORGANIC, A.O.S. [t? <br /> RO [PHOSPHORIC ACID) 8 P611 DF 1�4 F' - <br /> 14.Special Handling Instructions and Additional Information <br /> (1) 6R501149 - ERG(154) BE OX SOLUTION 12) 685815-88 - ERG(154) ACIDS Y/ ACETONE (TI (3) 686939-48 - ER61150 <br /> FLUODORIC ACID (4) 613322-88 - ER6(154} PHOSPHORIC RCID/YATE 6z) ,r x1.5-GAL- CS) )r 2c-<'GkL <br /> 15. GENERATOR'SlOFFEROR'S CERTIFICATION:1 hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, <br /> marked and labeled/placarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations.If export shipment and I am the Primary <br /> Exporter.I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a small quantity generator)is true. <br /> GeneratorslOfferoes PrintedlTypod Name Si nature - Month Day Year <br /> Lo'S c K c t ° 7 1 <br /> 16.International Shipments <br /> ❑Import to U.S. ❑Export fro . . Po try/exit: _ <br /> Transporter signature(for exports only): Dale leaving U.S.: <br /> UJ 17.Transporter Acknowledgment of Receipt of Materials <br /> Tr rsporler 1 PrintedlTyped Name Sign Manch pay Year <br /> a_ <br /> Cn <br /> M Transporter 2 PritedlTypName Si naure <br /> Month Day Year <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space <br /> ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> 186.Alternate Facility(or Generator) U.S.EPA ID Number <br /> ..r <br /> C? <br /> Facility's Phone: <br /> LOU 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> c <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> d I.� 2. 3. <br /> 4. <br /> 1)141 <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Printed/Typed Name Signature Month Day Year <br /> EPA Farm 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REIT <br />