Laserfiche WebLink
E <br />Please print or typt.d(Form designed for use on elite (12 -pitch) typewriter.) <br />• <br />DISC. <br />` GV97. 1963 <br />Forint Approved. OMB No. 2050-0039 <br />EPA Forth 8700-22 (Rev. 3-05) Previous editions are obsoleteDE ATED F C TO DESTINATION STATE (IF REQUIRED) <br />10265.1164 <br />UNIFORM HAZARDOUS 1. Generator ID Number <br />CAUXO194471 <br />2. Page l of <br />I <br />3. Emergency Response Phone <br />800-733-9W0 <br />4. Manliest Tmchln <br />0 2 913101 <br />Number <br />JJ K <br />WASTE MANIFEST <br />5. Gene2bls.Name and Matiina Address Generator's Site Address (it different than mailing address) <br />SERVICES INC. <br />CP..00. BFiOAXL241001 Y WASTE 1333 EAST TURNER ROAD <br />LODI. CA 95240 L.ODI. CA 95240 <br />Generator's Phone: 209-333-5615 <br />6. Transporter 1 Company Name U.S. EPA ID Number <br />CHICO DRAIN OIL SERVICE CAOM94103 <br />7. Transporter 2 Company Name U.S. EPA ID Number <br />8. �y U.S. EPA ID Number <br />' l <br />—,17� 6S:'Vr/� a/ 6�7�93 <br />see. R p?�D /✓. 14140 ppi <br />�irr o.✓GgT <br />J9oa��- 7 00 <br />Fadlitys Phone: """��' ,��o•S,7 <br />ga, <br />9b. US. DOT Desorption (including Proper Shipping Name, Hward Class, ID Number. <br />10. Containers <br />11. Total <br />12. Unit <br />13. Waste Codes <br />NO. <br />Type <br />HM <br />and Panting Group a�ny))� <br />Quantity <br />WtNol. <br />`(A <br />OM <br />Os <br />G <br />cid <br />f?G. �90%ire O.rn/sem§ <br />Z <br />2. <br />W <br />3. <br />4. <br />14. Special Handling lnstriletions arM difional lgkinnation - <br />61 <br />WEARPGLOVES AOI EYE P�ROTTEE�N- 24 HOUR EMERGENCY CONTACT EMTREC 424-9300 AND CHICO DRAIN OIL SERVICE <br />8733.9043 <br />15. GENERATOR'SIOFFEROR•S CERTIFICATION: I hereby declare that the contents of this consignment am fully and accurately described above by the proper shipping name, and are classified, packaged, <br />marked and IabeledlplaaNed, and are in all respects in proper condition for transport according to aptdipble international and national governmental regulations. If export shipment and I am Ore Primary <br />Exporter, I certify that the contents of this consignment conform to the terms of the attached EPA AccoMedgment of Consent. <br />I ce2fy that the waste minimization statement identified in 40 CFR 262.27(a) (if I am a large quantity gweator) or (b) (ifI am a smog quantity generator) is true. <br />Generatrds/Ormors Pnntedyfyped Name Signature Month Day Year <br />ELb 1 r)-[,+ D <br />F <br />16. International Shipments <br />❑ Import to U.S. ❑ Export horn U.S. Pon of anbyledt <br />Transporter signature (for exports any): Date Ieadng US.: <br />w <br />17. Tamponer AtlurovAedgment of Receipt of Malermis <br />Transporter 1 Pnr�nedy/Typed Name skinonM Day Year <br />Transporter 2 PrinteNTyped Name 3g Month Day Year <br />C <br />t— <br />18. Discrepancy <br />tae. Discrepant' lnaicebon Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑FWIRejection <br />Manifest Reference Number <br />r <br />lab. Alternate Facility(or Generator) U.S. EPA ID Number <br />J <br />U <br />Facilitys Phone: <br />W <br />led. Signature of Alternate Faaliy(Or Generator) Month Day Year <br />Q <br />z <br />H19. <br />Hazardous Waste Repart Management Method Codes (i.e., codes for hazardous waste treatment. disposal, and receding systems) <br />7. <br />4. <br />20. Designated Facility Omer or Operator CeMiwtion of receipt of hazardous materials covered by the manifest except as now in Item laa <br />l <br />MontsOay <br />P tedRyped Name Signature Year <br />&J r� s C4 A -AA JCA, 8 <br />EPA Forth 8700-22 (Rev. 3-05) Previous editions are obsoleteDE ATED F C TO DESTINATION STATE (IF REQUIRED) <br />10265.1164 <br />