COMPLIANCE INFO_PRE 2019 - Laserfiche WebLink

Home Browse Search

Please picot or".(Form designed for use on elite(12-pllch)typewdtec) Fun Approved.OMB No.2050-0039 UNIFORM HAZA 1.Gemrelar 10 Number 2 Page 1 of g.Errargency Response Phone 4.Maniaat Tracking Number WASTE MANIFEST C D 9 B 2 3 5 6 9 9 1 , aoo).x249300 005918416 JJ K 5.Geneatofs Nameam Mal Address Genareloes Site Address d'droronr than wailing address) MW MCRANE 1�YORKS PO BOX 989 2373 MARIPOSA ROAD LA PORTE TX 77672 STOCKTON CA 96206 Genermars Phone: 209 454-7636 6.Transporter 1 Company Name U.S.EPA ID Number gg ASBURY ENVIRONNENTALSERVICES C A D 0 2 8 2 7 7 0 3 6 t 7.Transpolar 2 Company Name U.S.EPAID Number E: 8.Designation!Facility Name and Site Address U.S.EPAID Number SIEMENS WATER TECHNOLOGIES CORP. v 6375 SOUTH BOYLE AVENUE LOS ANGELES . .CA _ 90068 C_.A_.D.:.Q 9..7...0....3....0-_9 9 3 Feel IsPhone: p23)277-1500 91 1b.U.S.DOT Deacdoon(Ndudktg Proper SNppkq Name,Hazard Case,ID Number, 10.Corlairsrs it.Total 12.Unit r, HM and Padding Group(it any)) No. Type Duenity WINd. 13.Waste Codes pFpF k 352 g NON-RCRA HAZARDOUS WASTE, SOLID(OILY SOLIDS) n M X40 P Z 2, I: 3. I 4. i 14.Special Handling Insauctons and Additional Information NAERG#981 : 171'PROFILE#981 :AP 181169 OILY SOLIDS,ABSORBENT, SWEEP'PO#A110112907 O R PERSONAL PROTECTIVE EOUIPNrENT -,o 15. GERERATOR'S/OFT'EROR'$CERTIFICATION:I herxby declare that the contents of this consignment are fiaty and aauraraty described shove by the propershpphg narna,ab are classified,packaged, marked and labeladlplacarded,and are in all respects in proper owfillon fa i masport according to applicable Ntemaaonal and rational governmental regulmorw.If export shipment and I am the Piki Expaler,I certify that the cmtenle of this consignmentconfarn to the terms of the attached EPAAclmowledgmenl of Comm. I I certify that the waste mi imbation statement identified In 40 CFR 26277(x)(N 1 am a large quantity generator)or(b)(ifI am a smell quantity generator)Is Inm. Generelcesl0eerars NnWyped Name SignaNre Monty Day Year AI Me j 0 11 ccleP l 111a 16.International Shipments ❑Impost to U.S. ❑Expos from U.S. Pon of sneyletdt: Transposer sgnrture(for exports only): - Date leaving U.S.: w17.TransporterAcknowledgmart of Raceiptof Materials - TransporterlPMnte0ypedName 5 Month Day Year CL f 6v o Transporter 2 PrimedRyped Name Slgratnra unN Day Yaer 1e.Discrepancy - 189.Discrepancy Indication Space ❑ Duantlty ❑Type ❑Resldue ❑Partial Relectlm ❑FWI Re ddw Manifest Reference Number: I&Alternate Facility(or Gendismar) U.S.EPAID Number J _ V LL Fedivs Phone: 1&.Signature ofARemalFadity(or Generator) Month Day Year a z y19.Hazardous Waste Repos Management Method Codes(i.e.,codes for harardws waste sentiment,disposal,and reryGhg systems) 1. 2. 3. 4. 20.Designaral Nodlity Domer or Opera ariimatdn of moolpt of hero s mate' s rad by the mangest ex*as noted in Item 1 1 Rlnted/fyped Name Sign aNe Month Day Year EPA Farm 8700-22(Rev.305) Pr I es 5ditions are obsolete. DESIGNATE LITYTO D TI ATION STATE(IF REOUI ED)