Laserfiche WebLink
GtiFS'.ER. >f 1-469 <br /> 41ON•HAZARDOUS 1,Generator ID Number 2.Page 1 of 3.Emefgency Raeponse Phone C Waste Tracking Number <br /> WASTE MANIFEST C A b 9 $ 0 8 8 4 8 1 5053 <br /> Q� 221 ' <br /> 5.Generator's Name and MailingAddress Gonerato(s Site Address Of different than mailing address) <br /> $ILGAId C:0NTATNER C0RP. <br /> 38=5 WAVY DRIVE <br /> STt:�CXTCN, CA. 95206 <br /> Genorator's Phone: Z 0 9 466-1003 <br /> 6.Transportar 1 Company Name- U.S.EPA ID Number <br /> UNIT:AR IUS A IT)C. <br /> 7.Transporter 2 Company Name US.EPA 10 Number <br /> 1,iT DIP PEE EXPRESS INC N JT D 9 8 G 6 0 7 3 8 0 <br /> S.Designated Facility Name and S'da Address U.S.EPA ID Number <br /> VECLIA E'S TECH SOLUTI011S <br /> .5736 WEST JF:EF•EPSQtd S'I. <br /> PH(JENIX, AZ 8,5043 <br /> Fadfit's Phone: _ (� t•= F rj-r�p U <br /> 9a' �,U.S.DOT I>�errtbn 10.Conlalners 11.Total 12.Unit <br /> HM <br /> No. Typo Quantity Wt.NoI. <br /> 1 UNIVERSAL WASTE - LA-4-PS <br /> p ;SPENT FLUORESCENT LIGHT TUBES) ( C n <br /> a <br /> rr <br /> LU <br /> LU <br /> 3. l <br /> _c <br /> 4. --- <br /> • I <br /> •4 <br /> 13. Spacial Handling Instructions and Additional Information <br /> 1. 522724 <br /> F'LFCARVIS PRUVIDED BY CARRIFiFt,/SMAPE.h YES/N0 DRIVER, SIGNKHRE <br /> *** ER CALLER MUST IDENTIFY UNIV'AR 1.TSA AS REGISIrRANT *��* �� __ -•----__-. _� <br /> 14.GENERATOR'S10FFER0RJ CERTIFICATION:I hereby declare that the contents of this consignment are fully and accurately descrbed above by the proper shipping name,and are classified,packaged, <br /> marked and labeledlplaeardod,and are in all respects in proper condition for transport according to applicable international s d national governmental regUaficns. <br /> Generator' , or's Prtntedit ed ame Signal Month Day Year <br /> j <br /> 5. e�m lieal Shipments � <br /> l <br /> ❑import to U.S. ❑ <br /> P Export from U.S. Port of entry/exk: <br /> Transporter Signature(for exports only): Date leaving U.S.: <br /> 16.Transporter Acknowtedpmont of Receipt o1 Materials --_ <br /> Transporter 1 Printedlryped Name "" Sig lure Month Day Year <br /> a .Vo _ <br /> 4 < Transporter 2 Pdnted Typed Name ire Month Day Year <br /> h <br /> 17.Discrepancy <br /> 17a.Discrepancy Indication Spare <br /> ❑Quantity ❑Typo ❑Residue ❑Partial Rejection ❑Full Re <br /> 1ectlon <br /> 3 <br /> Manifest Relorence Number: <br /> r 17b.Alternate Facility(or Generator) - -— <br /> U.S,EPA ID Number <br /> .3 <br /> U <br /> u- Facility's Phone: <br /> w 17c.Signature of Alternate Facility(or Generator) Month Day year 'F <br /> 4 I i <br /> 18.Designated Facility Owner or Operator.Certification of recelpt ai materials covered by the manitesi except as noted in Item 17a <br /> PrintediTyped Name Signature Month Day II Yea <br /> DESIGNATFD F:ACILITYTO GENERAroR <br /> £00Z SHIVS XNVUHHAIH f NoilmooZS NVDIIS TS96 S9V 609 XVA 9Z:9T 9002/TT/V0 <br />