Laserfiche WebLink
Please print or•type.(Form designed for use on elite(12-p8oewriter.) - • Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator 10 Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST C.A L 0 0 0 3 7 7 2 8 6 i (M)818-008 7 1000781271VES <br /> 5.Generators Name and Mailing Address Generafors Site Address fit different than mailing address) <br /> F�rc+iv Ph�kaging Inc, PACTIV PACKAGING INC <br /> DFA PACTIV L1.;_: 4545 QANTAS LANE <br /> 4545 QANTAS LANE <br /> Generators Phone: '09 483-6014 STOCK'TON, CA 95906 STOCKTON, CA 95206 <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> VEOLIA ES TECHNICAL SOLUTIONSRECEIVED I N I D 0 8 0 It 3 1 3 6 9 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> NOV 07 2013 <br /> 8.Designated Facility Name and Site Address V FOLIA ES TECHNICAL SOL°UTIONS, U.S.EPA ID Number <br /> 1ENVIRONMENTAL <br /> 1770404 W. FIRST STREET <br /> Facility's Phone: 626 534-53 t7 riZUSA,A, CA 91702 HEALTH DEPARTMENT C A D U' 0 8 = 0 2 4 0s <br /> ga 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit <br /> HM and PaciNo. Type Quantity WWoI. <br /> dng Group(If any)) 13.Waste Codes <br /> of 1. NON-RCRA HAZARDOUS WASTE LIQUID. (USED MOTOR <br /> o OIL) <br /> � 3 DM 1200 P <br /> cc <br /> w 2' NON-RCRA HA$FiRDOUS WASTE LIQUID. (INK SLUDGE) 491 <br /> co <br /> 4 D M 21 84 P -- <br /> a. 'NON-RC.RA HAZARDOUS WASTE SOLID, (INK SOLID'S) 5. 9 <br /> M 990 P - <br /> 4. <br /> I <br /> { <br /> 14.Special Handling Instructions and Additional Infernedon ER Service Contracted by VESTS + 1)7:277206 A'.-k?U4`UEL>7 2?7:10083A'REC <br /> WATER(NDMA) 3)W:10082 A.A J-DEBNUELtNS <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 are classified,packaged, <br /> marked and Iabeledlplacarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations.If export shipment and I am the Primary <br /> Exporter,I Partly that the contents of this consignment conform to to terms of the attached EPAAcknowledgment of Consent. <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)(R I am a large quantity generator)or(b)(if I am}9mall quad" �ator)is true. <br /> GeneratorsfOtiem, Prin \ame n. Signature 1�', f f 4.. Mont - Day Year <br /> Ie <br /> j 16.Intemationa hipments " ' `^ <br /> 1- ❑Import to U.S. Export from U.S. •Port of entrylexit: <br /> Transporter signature(for exports only): Date leaving U.S.: <br /> W17.TransporterAcknowledgment of Receipt of Materials <br /> Q Transporter 1 Pirtedfryped Name Signature _ Mont Day Year <br /> 2Q Transporter2 Pdntedlryped Name Signature-../ Mont Day Year <br /> K <br /> 18 Discrepancy <br /> 18a.Discrepancy Indication Space ❑ puan' <br /> My 1-1 Type El Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number. <br /> 18b.Alternate Facility(or Generator) _ U.S.EPA ID Number <br /> J <br /> U <br /> LL Facility's Phone: <br /> W 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> Q <br /> z <br /> y19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> Io i. 2. 3. 4. <br /> 20.Designated Faulty Owner or Operator.Certification of receipt of hazardous materials covered by the manifest except as noted in Rem 18a <br /> PdntedRyNam Signature Month Day Year <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. GENERATOR'S INITIAL COPY <br />