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COMPLIANCE INFO_PRE 2019
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2200 - Hazardous Waste Program
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PR0531068
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COMPLIANCE INFO_PRE 2019
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Last modified
1/27/2022 2:45:48 PM
Creation date
12/26/2018 1:44:11 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2200 - Hazardous Waste Program
File Section
COMPLIANCE INFO
FileName_PostFix
PRE 2019
RECORD_ID
PR0531068
PE
2220
FACILITY_ID
FA0004538
FACILITY_NAME
KMART #4062
STREET_NUMBER
255
STREET_NAME
NORTHGATE
STREET_TYPE
Dr
City
Manteca
Zip
95336
APN
21619008
CURRENT_STATUS
02
SITE_LOCATION
255 Northgate Dr
P_LOCATION
04
P_DISTRICT
003
QC Status
Approved
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SJGOV\kblackwell
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EHD - Public
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Please print or type. Form designed for use on eliter12- ch ewriter. PWe ed. 0UNIFORM HAZARDOUS WASTE MANIFESTeneratorID Number 22.Page 23.Manifest Tracking Num(Continuation Sheet) L000231582 o f 008680095FLE <br /> 24 Generators Name <br /> Kluart #4862 <br /> 25. Transporter Company Name U.S.EPA ID Nu AL <br /> DFRARTMENT <br /> 26. Transporter Company Name U.S.EPA ID Number <br /> 27a, 27b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 28.Containers 29.Total 30.Unit <br /> HM and Packing Group(if any)) No. Type Quantity Wt.Nol. 31.Waste Codes <br /> 5, Non RCRA hazardous waste, solid 1 DF 00081 P 561 <br /> I— <br /> G. Non RCRA hazardous waste, liquid 4 DF 00563 P 561 <br /> 7.Non RCRA hazardous waste, solid (Non—PCB 4 CF 00154 P 181 <br /> Ballast), <br /> 0 <br /> w <br /> Z <br /> LU <br /> t7 <br /> 32.Special Handling Instructions and Additional Information a e Regu a a o i s a ]e ��egu a e <br /> Liquids) 7. 1@3408(Lamp Ballasts) <br /> 33.Transporter Acknowledgment of Receipt of Materials <br /> W Printed/rName <br /> Signature Month Day Year <br /> O <br /> a <br /> Z 34.Transporter ment of Receipt of Materials <br /> Printed/Typed Name Signature Month TFF-7ear <br /> 35.Discrepancy <br /> J <br /> U <br /> Q <br /> LL <br /> 0 <br /> W <br /> Q 36.Hazardoul Wiste,RM nagemenl Method Code i.e. for h rdous waste treatment,dis I recycling systems) <br /> Z (�`J <br /> 0 <br /> rn <br /> w <br /> o g <br /> EPA Form 8700-22A(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br /> 8700-22a_12v3 CAL20070093 S40059094 040gPAI F.1 M nnaoaa,-7 <br />
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