Laserfiche WebLink
-?k 500 P.C.QtIx 400 Nxcarrwdo,Ca.32112-001vithin 30 <br /> r0--4- 4 <br /> Pleas4finitortype.(Form desIgned for use on ellte(112-pill typewriter.) Zq_ Form Approved.OMB;Niy*20507003 <br /> UNIFORM HAZARDOUS 1.GonwatorID Number 2.Page 1 of 3.Emergency Response Phone 14.Merl Tracking Number <br /> WASTE MANIFEST I 009434331:-,.,,JJK <br /> S.,Genemtoe?apewd,MallingAddres!,., e, GenemtoesSileAddms;(ifcrrffemntthaqroalingaddre§s) <br /> C <br /> Generator's P he no <br /> 0 <br /> 6.Transporter I Company Nam U.S.EPA ID Number <br /> V_V01e1'1PZEN EWASONNIENTAL SE,"WICEZ CAM12413282 <br /> 7.Transporter 2Company Name U.S.EPA ID Number <br /> B.Designated Facility Name and She Address Eviiiic'ARFEN OIL, INC, U.S.EPAIDWmber <br /> 083') GMITH AVENUE <br /> NV4YARK CA 94580 CA498=7418 <br /> Facill Phone: 610_79i-44"D <br /> ii, 9b.U.S.DOT Description(mclucling Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes <br /> HM and Peeking Group(ifany)) No Type <br /> Quantity WLNOL <br /> 1. <br /> ix K.`%ZAR1)Oj WA IM, LICUID 001 TT G <br /> Z 2. <br /> 3. <br /> 4. <br /> 14.Special Handing Instructions and Additional In <br /> ralll '�!' <br /> PROFILE I INVOICE . <br /> D <br /> 01' ET" 171 WEArl PROTECTIVE" CLOTHING SALES CIFIDER <br /> 15. GENERATOR'SIOFFEROR!SCERMCA71ON: I hereby declare that the contents of this consignment am fully and accurately described above by the proper shipping name,and are classified,packaged, <br /> marked and latheleciplacarded,and we in all respects in proper condition for transport according to applicable international and national govemmental regulations.If export shipment and I am the Primary <br /> Expor1w,I certify that the contents of this consignment conlom to the terms of the alladwd EPA AcknoWedgment of Consent <br /> I certify that the waste minimization statement identified in 40 CAR 262,27(a)(if I am a large quantity,gerwall or(b) dl am a molluantity,generator)is bus. <br /> ay Year <br /> GenwatoeslOffiemesl?' yped Name M J I / ). -' <br /> yore 77 D V, <br /> _u 116.International Shipments Elf.penteu.s. <br /> I__ ElExped to.U.S. Port of entrylaidt <br /> K Trammel signature,(for exports only): Date leaving U.S.: <br /> IX 17.TransportmAdmavledgment of Recall of Materials <br /> Transporter I Pdntedrryped Na Signature, <br /> Morb Day Yeg <br /> 0 7/ .1 12 1tz 1/ .5 <br /> CL <br /> Transporter 2 pritedlTyped Name Signature Month Day Year <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Spam D Quantity 1:1 Type E]Residue 1:1 Partial Rejection ❑Full Rejection <br /> Manifest Reference Number. <br /> 16b.Alternate Faculty(a Generator) U.S EPA ID Number <br /> E5 V t <br /> LL Facilitys Phone: <br /> 18c.Signature of Alternate Facility(a Generator) <br /> AUG 26 Monza Day Year <br /> 2, <br /> 19.Hazardous Waste Report Management Method Codes(I.e..codes for hazardous mail traalrnenl,disposal,and recycling systems) <br /> 1, Z 3. <br /> IRE)NMENTl <br /> r2ioDee1q,ated Factily Omer or Operator.Certification of recalot of hatardous materials covered by the manifest except as rated in Itamn 16a <br /> Printedityped Name, Signature Month Day Year <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolet.e. GENERATOR'S INITIAL COPY <br />