Laserfiche WebLink
0 <br />F d ' d f an elite 112- itch) h,ewriter) Form Approved, OMB No. 2050-0039 <br />rrease <br />pant or type. ( Crtn astgne <br />or use p p <br />1. Generator ID Number <br />2. Page 1 of <br />3, Emergency Response Phone <br />d. Manifest Tracking Nu <br />UNIFORM HAZARDOUS <br />003936656 FLE <br />WASTE MANIFEST <br />CAL0001944?1 <br />1 <br />866-333-9222 <br />5. Generators Name and Mailing Address Generators Site Address (ifdi@erent than mailing address) <br />Central Valley Taste Services Inc <br />1333 E Turner Ad. <br />Lodi, Ca. 95240 - <br />GeneralorsPhone. rano aaa 5611 <br />6. Transporter Company Name U.S. EPA IO Number <br />Advanced Chemical Transport CAR000070540 <br />7. Transporter 2 Company Name U.S. EPA ID Number <br />e. Designated Facility Name and Site Address U.S. EPA ID Number <br />Chemical 'Paste 11anagement <br />35251 Old Skyline Road <br />Aettleman City, CA 93239 <br />Facility's Phone: 559-386-9711 CAT000646117 <br />9a. <br />9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, <br />10, Containers <br />11. Total <br />12. Unit <br />13. Waste Codes <br />No. <br />Type <br />HM <br />and Packing Group (d any)) <br />Quantity <br />WINoI. <br />I . Hon RCRA Hazardous taste, SOlid (Oily Solids)UJI <br />352 <br />z <br />2. <br />3. <br />I <br />4. <br />14. Special Handling Instructions and Additional Intonation <br />1) CA600162; CEC-00( / �� 5,5, D�J <br />Project Number: 1038129bb <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 Iabelecifplacarded, 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 certify that the contents of this consignment conform to the terms of the attached EPAAcknmwledgment of Consent. <br />I cedify that the waste minimizallon statement identified in 40 CFR 281 (if I am a large quantity generator) or (b) (if I am a small quantitygenerator) is We. <br />ener toes/Ofe a Pill ted) Sii Month Day Year <br />VL si 10) 619 I, <br />ii <br />p_ <br />national shipments <br />18. tem <br />Import to U.S. L1 Export from U.S. Port of entry/exit <br />= <br />Trans iter si nature for exports only): Date leaving U.S.: <br />17. Transporter Acknowledgment of Receipt of Materials <br />tL <br />Tran der 1 Phnted/Typed Namil e q n r on ay car <br />ora aB <br />o <br />Q.�e <br />� <br />Gansporter2 <br />y <br />rintedRyped Name Signature Man a ear <br />rY <br />t— <br />18. Discrepancy <br />18a. Discrepancy Indication Space ❑ Quantity ❑ Type ❑ Residue ❑ Parral Rejection ❑ Full Rejection <br />Manifest Reference Number. <br />18b. Alternate Facility (or Generator) U.S. EPA ID Number <br />J <br />U <br />LL <br />'s <br />Fadlil Phone: <br />w 18F Signature of Alternate Facility (or Generator) Month Day Year <br />Q <br />Z <br />� 19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) <br />w 1 <br />D <br />2. 3. <br />4. <br />O. Des noted Facility Operator. Codification of receipt of hazardous materials covered by t a x o ad In Item 18a <br />Pd ed YP <br />to <br />e <br />tM <br />EPA Forn) 870422(Rev.3-OSrFrevious edmonS are obsolete. - J UlESIGNAI tU FACILITY IU UCJrmAii a iAi c tlr rccuuincut <br />