Laserfiche WebLink
Metadata
Document management portal powered by Laserfiche WebLink 9 © 1998-2015 Laserfiche. All rights reserved.
- � IIIIlIIIfIN�llllllllilIIIlllllillllttlllllillllllllllllltllllilil <br /> Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-p039 <br /> UNIFORM HAZARDOUS 1.Genera'ID_W <br /> umber 2.Page 1 of 3.Emergency Response Phone 6.Manifest Tracking Number <br /> WASTE MANIFEST CAL00033,7276 - (80(1)326-1221 G(�U3443!HUYNH] <br /> 5.Generators Name am Mailing Address Generators Site Address In di Brent than mailing address) <br /> PACIFIC ETHANOL STOCKTON, LLC 1 THAD HUYNH PACIFIC ETHANOL STOCKTON, LLC ,' TH <br /> .3028 NAVY DR 3028 NAVY DR <br /> STOCKTON, CA 952OF STOCKTON CA 95206 <br /> Generators Phone: ('2'09)'2'35-0370 GEN: 120323 <br /> mrlsponer 1 ompany arae U.S.EPA 10 Number <br /> J II It'D058484114 <br /> 7.irareponer2 Company Name U.S.EPA ID Number <br /> I.Designated Facility Name and She Address U.S.EPA ID Number <br /> HERITAGE ENVIRONMENTAL SERVICES <br /> 7901 WEST MORRIS STREET IND 093219012 <br /> INDIANAPOLIS IN 46231 <br /> Facilityxs Phone: (317)243--0811 <br /> ga. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Tofal 12.Unit <br /> HM and Padang Group(Many)) No. Type Quantity WLNOL 13.Waste Codes <br /> 1. <br /> o X RD UN3264WASTE CORROSIVE LIQUID, ACIDIC, 1 DF 25 P _ Al- <br /> aa, INORNINIC, N! 0.S. ,8,PGIII, (SULFURIC ACID, <br /> W MFPrIIPV, PTI li - nC.1 <br /> 2c 2. <br /> W <br /> C7 <br /> 3. <br /> 4. <br /> AL 1 412014 <br /> 74.Special Handling Instructions and Additional Infopnalion1. ENVI RO N ti9 <br /> Wi_0635466 (1) DEPARTMENT <br /> q :HERITAGE r15375131S <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: 1 hereby declare Mat the contents of this consgnmentare fully and accurately described above by the proper shipping name,and are dassified,packaged, <br /> marked and labeled/placarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations.If expos shipment and I am the Primary <br /> Exporter,I pertly that the contents of this consignment conform to the terms of the attached EPAAcknowtedgment of Consent. <br /> I codify that the waste minimization statement mail in 40 CFR 262.27ja)(if I am a large quantity generator)or(b)(MI am a small quantity generator is nue. <br /> enroto cors Printe yped Name ign on ay ear <br /> J 16.International pm <br /> onal sltienls <br /> P ❑hoDon M U.S. ❑Export from U.S. Part of entry/exit: <br /> Transporter signature for exports only): Date leaving U.S.: <br /> W 17.TranspoderAcknowledgmenl of Receipt of Materials <br /> Transporter l PtniedRyped Namegnature n y Year <br /> QL _ ar <br /> �I <br /> QTransporter2 PrinteNfyped Name ignaWre onthaY Year <br /> C <br /> r <br /> ♦ 16.Discrepancy <br /> 16a.Discrepancy Indication Space ❑ Quantity ❑ ❑ ❑ 1 ❑Full Rejection <br /> YPe Residue Portal Re'ection <br /> Manifest Reference Number. <br /> 1 W.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> V <br /> Q <br /> �- Fapif 's Phone: <br /> ,�ys18c.Sgnature of Allemate Facility(or Generator) <br /> Q Month Day Year <br /> s <br /> m19.Hazardous Waste Report Management Method Codes(i.e.,cedes for hazardous waste treatment,disposal,and re <br /> w D cycling systems) <br /> 2. 3. 4. <br /> H010 <br /> 20.Designated Facility Owner or Operator Codification of receipt of hazardous materials covered b e manifest except as edIn!!jsq18a b_ <br /> ed Name gnaWre Si <br /> Month Day Year <br /> r <br /> EPA Form 8700-22(Rev. 5) Previous editions are obsolete. DESIGNATED FACILITY=ESTNli STATE(IF REQUIRED) <br />