Laserfiche WebLink
IIIlllifllillllflllllllll II IIIII 1111111111111111111111111 <br /> Plea se print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved OMB No.2050039 <br /> UNIFORM HAZARDOUS 1.Geriemlw ID Number 2.Page l of 3.Emergency Response Phone 4.Manifest Tracking Number <br /> WASTE <br /> WASTE MANIFEST c 9 . 8 7 7 8 209-993-9136 oO O6J FLE <br /> • S.Generators Name end Mailing Address Generators Site Address(RdiRerenl than mailing address) <br /> U3 Intec Inc. US Inter. Inc. <br /> 3301 H. Flavone Rd 3301 Il.' Havone Rd <br /> Stockton, CA 95208 Stockton, CA 95200 <br /> Generators Phone: 209-292-5014 Maria Lewis <br /> .Trensporterl Comp any oma <br /> Te1 ; LL(`S1.'gE_PA ID Number <br /> aA <br /> 7.Tmnsponer 2 Company Name REGEIVEDU.S.EPA ID Numher 7 <br /> 6.Designated Facility Name and Site Address i '(, r 2 013 U.S.EPA ID Number <br /> RIHSCO <br /> 1007 Vulcan Road ARD 9 8 1 0 7 8 7 0 <br /> Benton, AR 72015 ENVIRONMENTAL <br /> Fao7i is Phone: 501-779-9099 rr4! <br /> ga, go.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 QuantityNANOL 13. ste Codes <br /> W % 1' UH1993, Waste Flammable liquids, n.o.s. (Petroleum DF P 331 D001 <br /> f, Asphalt, Mineral Spirits), 3, PG III 3862 <br /> z 2. <br /> w <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions andAdditiomdl Information <br /> 1. 1306-08443 Ell 128 Matrix 204 Standard Net/Dry cement <br /> 15. GENERATOR'S/OFFEROR'SCERnFICATION: I hereby declare that the contemn OFlhis consignment are fully and accurately described above by the proper shipping name,and are clan ifiad,packaged, <br /> marked and hbeleNplacsided,and are in all respects in proper condition far transport according to applicable international and national governmental regulations.If export shipment and la n the Primary <br /> Exporter.I cedy that the contents of this consgnmenl common to the tenns of the attached EPAAcmowledgment ofConsent, <br /> I ceftity that the waste minimization statement iden80ed in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(dl am a small quantity generator)is true. <br /> Generetors/ORerors Pnnted/lyp Name gna re n By ear <br /> See Attached <br /> —r <br /> 16.International Shipments <br /> See Attached <br /> 1- ❑Impodto U.S. ❑Evmtfrom U.S. Pad ofen1 lex8: <br /> Trans Ser stgnature for exports 22UDate leavin U.S.: <br /> w 17.TrenspoderAcknowhogmentof Receipt of Materials <br /> Transporter 1 Pnntedrryped Name <br /> O �gnaWre nt <br /> IO I DayYear <br /> Z <br /> 7ransportsr2 Pdnted yped Name~ nature <br /> K on ay ear <br /> F <br /> r18.Discrepancy <br /> 18a Disaepanq Indication Space <br /> © Quantity ❑Type ❑Residue ❑Partlal RejecBon FWI Rejection <br /> Rineco received 3862P on line item 11(1).This discrepancy was resolved within 15 days.See above correction. <br /> �. 106.Alternate Facony(or Generator) Manifest Reference Numher. <br /> � U.S.EPA ID Number <br /> U <br /> LL Fad •s Phone: <br /> 16c.Sgnalure mAIlernaw Fadlay for Genemm) <br /> Muni Day Year <br /> a <br /> z <br /> .y 19.Hazardous l bste Report Management Method Codes(i.e.,codwfor hazardous waste treatment,disposal,and recycling systems) <br /> 1' (1061 2 3. q, <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the mantfest except as noted 1n Item 18e <br /> Pd yped Na Signature Month Day Year <br /> Lew C. } r <br /> EPAFonn 0700.22 Ray.3-05), revlous editions are obsolete. tw ^'^,..,.M--. __ _- <br />