Laserfiche WebLink
Please pdntcr type.Form designed for use an elite(12- Bch)rypewrilec) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1'Gerarxlor 10 Number 2.Page 1 of 3.Emergency Response Phone 6.Manifest Tracking Number <br /> f.yyP4TE,MANIFEST C A D 9 6 2 3 5 6 9 4 1 1 pp� q,0¢g3pp 0'0.74 297-6:1Y. JJK <br /> S.Gari02IW5 Nyi�Niw9d ft General Site Address if different than ml address) <br /> MiXIM WUIit1S � <br /> PO BOX 999 7373 M>RIPOSA ROAD <br /> LA PORTE TX 77572 STOCKTON CA 96206 <br /> lofa <br /> GeneraPhone: 209 464-7635 <br /> 6.Transporter 1 Company Name U.S.EPA 10 Number <br /> ASBURY ENVIRONMENTAL SERVICES C A D 0 2 0 2 7 7 0 3 6 [ <br /> 7.Transporter 2 Company Name : - U.S.EPAID Number pge <br /> S. res <br /> 1��tF U��S�f��U�F�NOLOGIES CORP. U.S.EPA 10 Number I <br /> �FI [ <br /> 6376 SOUTH BOYLE AVENUE <br /> LOS ANGELES CA 90068 C A D 0 9 7 D 3 0 9 9 3 <br /> _ <br /> Fed IIIPMne: <br /> ge. gb.U.S.DOT Cescdpaon Qrdudhg Pmpar SNpping Name,Hazard C1as,ID Mune,, 10.Containers 11.Tote) 12.UM { <br /> HM aMfertirp Greup pf anYN �. Typo Y yA,W. 13.Waster <br /> 352 <br /> Ix NON-RCRA FIAZARDOUSWASTE,SOLID(OILY SOLIDS) 7 lei t <br /> = 2 <br /> W i <br /> l7 <br /> 3. <br /> 4. . <br /> 14.Special Handling Insur oll ant Additional Information <br /> NAERQ#9B 1 : 171'PROFILE#981 :AP 181159 OILY SOLIDS,ABSORBENT,SWEEP*PO#Al 10127095APPROPRIATE <br /> PERSONAL PROTECTIVE EQUIPMENT <br /> It1225057 <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 ere classified,packaged, <br /> marked and Wbeledlplecerded,and are In all aspects In proper cond ion for mode t according to applicable Inlemational and national governmental regdallons.If expM shipment and I am the Primary <br /> Exporter,I dandify that the contents of tide consignment conform b 0%norms of the attached EPAAcknowledgment of Consent <br /> 1 cei that the waste minimization statement Identified In 40 CFR 262.27(3)(If I am a large quantity generator)or(b)(ifI am a sinal quantity generator)is m.e. <br /> attMervrs Pnntedor d Name S Month- Day- Year <br /> X. <br /> 16.Internaflanel SNpments ❑IrtkpMb2 <br /> U.9, ❑Export from U.S. Port of entry/ext: <br /> Transporter Signal(tare)parb amyl; Dale leaving U.S.: <br /> W IT Trarapoder AciowMedgmem of Receipt ofMatartels <br /> Trans 1 PanteteNfyped Nana S9. M <br /> Transporter nled(Type maSigi Month Day Year <br /> 16.Discrepancy <br /> 16a.DAvaepency Ind Callon Space ❑ adentity ❑ oe ❑Resi7ue ❑Parml R*dcn ❑Fri Rejsdmi <br /> Manifest Reference Number. <br /> A.r 18b.Alternate Fealty(or General U.S.EPA ID Number <br /> 7 <br /> E5 <br /> LL Faclkh/s Phone: <br /> a 16c.Signature ofNamalte Facility(a Generator) Month Day Year <br /> 2 <br /> W19.Hazard=ii Repoli Management Metlwd Codes(i.e.,codes for hazardous waste Ireahnent,disposal,and recycling system) <br /> 4. <br /> 20,Designated Fac;ity or or actor.Cafibcatlon of recsipt of haVws ma nals ered by the men6esl exwpl as nAedIdlta Ba <br /> Pm4edrryped Name Signature All Day Year <br /> EPAForm8700-22(Rev.3-S*d6o <br /> usediGonsareobsolee. DESIGNATED Wil STATE (IF.REQUIRED) <br />