COMPLIANCE INFO - Laserfiche WebLink

Home Browse Search

r.. i. (!ems.:=i,• o-�r - Z • �« 5.,� 'iZA- Please orint or hma. (Fium desinnarf frir uce on elite 119-nitrhl hmawriter.l M Form Approved. OMB No. 2050-0039 EPA Form 8700.22(Rev.3-05)'Previous editionsareobsolete. DESIGNATED FACILITY TO GENERATOR STATE (IF REQUIRED) 12168.0394 UNIFORM HAZARDOUS -i. Generator ID Number 2. Page 1 of 3. Emergency Response Phone r :�' 4 •Mamifest Tracking Number WASTE MAHIEEST ing 014380-358 JJ K 5.'Generator's Name and Mailing Address ' Generator's Site Address (d different than marling address) Ail MEt 1 YN BEWW�R BNSF RA1L{ArAY COMPANY BNSF RAILMY COMPANY 740 E CARNEGIE DR STOCKTON SUBOMSION MP1119.5 TRACK 139 SAN BERNAN.DINO CA 92408 `� STOCKTON CA 95208 Generator's Phone: 6. Transporter 1 Compo y ITERRe i, U.S. EPA ID Number NRC ENVIRONMENTAL SERVICES INC. It A R 0 0 0 0 3 0 1 1 4 7. Transporter 2 Company Name.�y r U.S. EPA ID Number 8. Designated Facility Name and Site Address U.5. EPA ID Number Fid Recycling Services i 80�W. Morae Ave. Fact t s Pho e1 ga. 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Cadalners 11. Total 12. Unit 13. Waste Codes HM and Packing Group Of any)) No. Type Quantity WtJvoi. tx UN3077. ENVIRONMENTAL HAZARDOUS SUBSTANCES, SOLID, 4x N.O.S., (DEBRIS. SODIUM METHYLDITHIOCARBAMATE). 9.111 Q' 00 t 3. -t 1 4. 14. Special Handling Instructions and Additional Information c� WAR. PROPER PERSONAL PROTECTIVE EQUIRYMM; JOS/P0# gl4'f a NRC _MNVXP1AD +lEWML BERVICES : 1805 FERRY SOIl3T, A.2JUMDA, CA 94501 `� 981) PROFIkE# 15050106, 2sc55G ! 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described a ve y the proper shipping name, and are classified, packaged, 1n a0 intemational regulations. If expbrt shipment and 1 am the Primary marked and labeled/placarded, and are in all respects proper condition for transport j; to applicable and national governmental .Fxpater, I certify that the contents of this consignment conform to the terns of the attached EPAedgment of Consent n I certify that the waste minimization statement identified in 40 CFR 262.27(a) (if I am a large quantity generator) or (b) (dl am a small quantity, generator) is true. Generatofs/Ofterofs PrintedlTyped Name/ R�� 1 / �� SignaWre"`�', � /' MoIlih D� Year., us - •FJ 16. International Shipments ❑ Import to U.S. ❑ Export Ban U.S. Port otentry/e�'i:t: Transporter signature (for exports only): Date leaving U.S:: W 17. Transporter Acknowledgment of Receipt of Materials 12 Transporter 1 Printed/Typed Name Signature Month Day Year a Mae Transporter 2 Printed/T Name Signature - Month Day Year 18. Discrepancy 18a. Discrepancy Indication Space ❑ Quantity El Type ❑Residue ❑Partial Rejection ❑Full Rejection:- ejection`Manifest ManifestReference Number. 18b. Alternate Facility (or Generator) U.S. EPA ID Number Fadiltys Phone: 18c. Signature of Altemate Facility (or Generator) Month Day Year 4 19. Hazardous Waste Report Managgjnent Method Codes (I.e., codes for hazardous waste treatment, disposal, and recycling systems) UJA l 2. 3. 4. i 20. Designated Fatality Owner or Operator: Certification of receipt of hazardous materials covered by the man pt as note N tem 18a Year Printedlfyped Name ` Sig Month DayC �)? k -h 1A �AM I C k tic 9 E EPA Form 8700.22(Rev.3-05)'Previous editionsareobsolete. DESIGNATED FACILITY TO GENERATOR STATE (IF REQUIRED) 12168.0394