Laserfiche WebLink
A 496073 10 1349790 <br /> Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Farm Approved.i No.2050.0039 <br /> UNIFORM HAZARDOUS 1.Generator 16 Number 2.Page i of 3.Emergency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST CAD009189069 2 (BOO) 535-5053 000037722 DAT <br /> 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) <br /> All Aerespace Structure Applied Aerospace Structure <br /> P.A. lox 5189 3437 50, AIRPORT WAY <br /> Generator's Phone: Stockton CA 957115 (209)983-3339 STOCKTON CA 952116 (209)983-3339 <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> 21st Century Environmental. Management of California, 1-F 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 /> GENERAL ENVIRONMENTAL 1115T, LLC 1IA PSC ENVIRONIIENTAL SERVICES <br /> 11955 WHITE ROCK ROAD <br /> Feellity'sPhone: RANCHO CORJOVA, CA 95142 (91131 351-0900 GAD90C188 183 <br /> 9a, 91 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)) No. Type Quantity Wt1UoL 13.Waste Codes <br /> 1 UN1263 WASTE PAINT RELATED MATERIAL 3 PGII 1001 , 1035 F803 <br /> RIDS 343 <br /> 2. UN1325 HASTE FLMILE "SOLIDS, O%RNIC, H.O.S. (I11jET1ONE, METHYL 11091 1035 F0113 <br /> X ETHYL KETONE) 4.1 PGII 0j— 0T1 t-w(' P <br /> F1J115 352 <br /> 3- UN11yI10 W(1STE POTASSILM CYANIDE fiJ PGI PAARINE POLLUTIANT°`TOXIC' D003 P098 14I <br /> RQ <br /> 0 1- P <br /> 4, NA3977 HURRDBUS WASTE, SOLID, N.O.S. (CHROMIUM 9 PGIII 111 1� <br /> IN P <br /> 14.Special Handling Instructions and Additional Information <br /> (I) GR6738-00 - ER6{1201 PAINT RELATED WASTE M GRI918-35 - ER11i SOLVENT WIPES (3) GR4439 -110 - ERG(157) POTASSIUM <br /> CYANIDE DE (4) GR6134-00 - ERIN PAINT BOOTH FILTERS C?)j '-Y-so &ll <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I 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 labeledlplacarded,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 EPAAcknawledgment of Corsent, <br /> I certify that the waste minimization statement identified in 40 CPR 21(if I am a large quantity generator)or(b)(if I am a small quantity generator)is true. <br /> Generalor's/Offeror's Printedayped Name Si nature r Month Day Year <br /> 16.International Shipments <br /> F-- ❑Import to U.S. ❑Export from Port a xit: <br /> z Transporter signature(for exports only): Date leaving U.S.: <br /> 6 17.Transporter Acknowledgment of Receipt of Materials <br /> Transporter 1 Printed/Typed Name Signature` I Month Day Year <br /> 0 1JF,-PLL-,4P2 <br /> Q Transporter 2 Printed/Typed Name Signature Month Day Year <br /> 18,Discrepancy <br /> 18a,Discrepancy Indication Space ❑ Quantity ❑Tye Residue Partial Rejection Full Rejection <br /> Manifest Reference Number: _ <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> FacilitysPhone: <br /> w 1 Be.Signature of Alternate Facility(or Generator) Month Day Year <br /> Q <br /> z <br /> Fn19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> w 1. 2, 3. 4. <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> PrintedlTyped Name Signature Month Day Year <br /> EPA Form 8700-22(Rev,3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(1F REQUIRED) <br /> tc�. z <br />