Laserfiche WebLink
AN - <br /> Pieasoprll�AVMRVOfti dealt yd for use on elite 12• itch)lypohrlter.) Form A rovad.OMB No.2050-0039 ; <br /> UNIFORM HAZARDOUS 1 Generator ID Numbor 2.Page 1 of 3, ergency Response Phone 4.Manifest TracKing Number <br /> _ 014054.412 JJK <br /> WASTE MANIaFEaSJT�:,a q sC�A 8 0 0 0 0 7 3 5 8 5 1 (800)4249300 <br /> 5,Goneralol WV <br /> C 1 rY(DTAg A RA078 Oeneraiars She Add ass(If dl sheet Then rat ng address) <br /> 2895 NORTH NAGLEE ROAD <br /> I <br /> TRACY CA 95376 <br /> ieneralor's Phone: 209 8941121 <br /> ranspnrer FtYnE� A'ONMENTALSERVICES U.S.EPAttmur <br /> CAD�78277036 <br /> 7,Transp(xWr 2 Company Go U.S.EFA ID Number { <br /> 8 �r0tUA WA1 EOi�NOLOGIES LLC U.S.EPA ID Number <br /> 537 SOUTH BOYLE AVENUE <br /> LOS ANGELES CA 90058 CAD097030993 <br /> padjWsPhone: (323)277-1500 <br /> i <br /> go, gb.U.S.DOT Description(iodudfrrg Proper Shipping Name,I'azard Class,ID Number, 10.Containers ti.Totaf 12.Unit <br /> HM and Packing Group(If any)) No. Type Quantity Wt.N01, <br /> 13,Waste Codes <br /> 1. R69-ice'HAZARMUS WASTe, L{ (OILY SOLIMY 352 <br /> D IV Ori P <br /> z 2. <br /> 3, <br /> 4. <br /> 14.Spocial Handling IrtstrLeta-m andAdd1hroil @forrnglicn <br /> EMERGENCY CONTACT:CHEMTREC 1-800-424-9300 NAERG#981:171 *PROFILE#F SOLIDS <br /> APPROPRIATE PERSONAL PROTECTIVE EQUIPMENT q <br /> 15. GBNERATOR'S10FFEROR'S CERTIFICATION:I hereby declare that the contents of this consignment ore idly and eo=aloly described above by the proper shipping name,and are classified,packaged, <br /> marked and labeled/placarded,and are in all respects in proper condition for lransport 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 EPAAcknowledgmenl of Consent <br /> I cad!(y that the waste minlmizallon statement Identified kr 40 CFR 202,27(a)(If I am a large quantlly generator)or(b)Qtf w a small quadtlly goner>ator)Is true. <br /> Ganeml, n ed Name 3rfftta oto Month nly Yaw <br /> --a 16,International ipments <br /> F ❑Import to U.S. Expcd from U.S. Pon of ertrylexii: <br /> Trans orter signature(for exports on : Date leaving U.S,; <br /> a 17.TranaporterAcknowledgmen'of Receipt of Materials <br /> aTrar9pp 1 Mei )adNano Sigrra ss — W&h Day Year <br /> � a� dt •(ra <br /> r2Pr a monih Day Year <br /> 1 t,Dlscropanoy �l <br /> 108.Discrepancy Indication Space Quantity ❑Type ❑Residue ❑Partial Re)ecdon LJ Full Rejocton <br /> Manifest Reference Number. <br /> 18b.Alternate Fidlity(or Generator) U.S.EPA ID Nuinber <br /> a <br /> U <br /> LL Fadflty's Phone: on bay Year <br /> d t 0c. Ignature of A fermate o '.Ity r Generator <br /> Y <br /> 19.Hazardous Waste Report Managamenl Method Codes(Le,codes for hazardous waste treatment,dispoeal,and recycling systema) <br /> 3' A <br /> 20.Designated Facllty Owner or Operator,Carlfilcotlon of recolpt of hazardous iratarials covered by the manifest except as acted In Item 18a <br /> P74016irwed Name, Algriature 1 nt Days A/61 ar <br /> eP td <br /> EPIiFo P-22(Rev.2-05) PtovIDu$Ottons are 6wleta. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />