Laserfiche WebLink
rt.sse r.rtnt or tyx 4., (Form designod tw use on•Idt•02-pitch)ryvowwitw <br /> UNIFORM HAZARDOUS 1. Generator's US PA ID No. Manilest 2.Page Iniormauon in the shaded areas <br /> tt No. is not required by Federal <br /> WASTE MANIFEST t �f law. <br /> enerstor s Name and -Mailing Address t n e ment. umber r <br /> Ca•J.i;ornia Dept. of Transportation 84bU <br /> - Box 2048 �- ' <br /> _ P.O.: <br /> StOCkton CA 520 B.Stat►. en.ratnra'ID <br /> gg CAD981158983•'_ <br /> G+nerator`■ Phone 2 0 9 9 4 8-7$0$ <br /> 5. rat{air I Company Narffe 6. US EPAJC) umber tate- rsnsptart <br /> 'Cc�lrremical Waste Managements CAD003986718. . . ronsporters Phone <br /> rfnsporter pany ame <br /> US EPA lD Number tats. rerlaportar-s <br /> I •M/rr nr . . ransportsr s� <br /> -7 eslgnat Facility ..Name ■ rte ress 10. U PA ID Number tatsc as a:-1 y�4 -� <br /> Che�zica]. Waste Inc. , Rettleman Hills Facil tg- # �a` `� ;�`:: <br /> 35251 Old Skyline Rd. ac►Ita., tx �- Y .. . <br /> Kettleman City, CA 93239 <br /> L-CAT0006461 17- `2 0 a — <br /> 12.Containers 13. 14. <br /> 11.US DOT Description(Including Proper,Shipping Mance Huard Claim and ID Nt/rrtber Total Unit <br /> o <br /> No. Type Quantity Wane Noy_: <br /> [r. Hazardous Waste Solid N.O.S. ORM-E I4A9389 001 DT 000 <br /> f j T b. `. "ra• <br /> A.-AV—-t` <br /> d. <br /> � ing Codra.fpr Waetea st <br /> 16.SpOcital <br /> Ir1g PlfirtrCLlOna trona -Inlotmation _ t <br /> L 1 ,r;'. I -A LTH <br /> I E;, i/SEnV10ES <br /> 18.GENERA eby d4wA&rothat the contents of this conslgnmencare fullyand accurately descri <br /> above by proper shipping nernis and are classifled.pecked,marked,and labials4,isind wain all rssaects in proper condition for <br /> transport 1 y highway according to apptir auris international and national r ntalr lati <br /> Date <br /> Pr Sartreah Sign ten_ ~roach Ur yr Ydei. <br /> T 17.Transporter 1 Acknowledgement of Receipt of Materials. LJ ( Date <br /> R <br /> A Prirttsd✓'T a Sign to e- Monrh Day yeer <br /> 7 <br /> rr <br /> l H 1 " <br /> 0 18.Transporter 2 Adtrwwfedgeti W_,eipi of Materials' Data <br /> T Printed/Typed Name Signature Manch Day Year <br /> e <br /> R <br /> 18. Discrepancy Indication.Space <br /> F <br /> A <br /> C <br /> 1 <br /> L <br /> 1 20.Facility Owner or Operator. Certification of receipt of hazardous materials Covered by Shia manifest except as noted in <br /> T ItemFlr19. <br /> Ortw <br /> IntName Ignature Month Day ear <br /> Blue: GENERATOR SENDS THIS COPY TO DOHS WITHIN 30 DAYS <br /> DHS 4022 A(7/14) To: P.O. Box 400, Sacramento, CA 95802 <br /> (EPA 0700-22) <br /> 84 dos.F <br />