COMPLIANCE INFO - Laserfiche WebLink

Home Browse Search

Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number C C WASTE MANIFEST p _ _ 007065809 1 LL 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) GB INDUSTRIAL SPRAY INC GB INDUSTRIAL SPT INC 1140-3 BESSEMER AVE 1140-3 BESSEMER AVE MANTECA CA 95337-6108 MANTECA CA 95337-6108 GeneratoesPhone"'.U,q-825-7176 ATTN: LINDA G)ODNOUGh 6. rans orter 1 Com an Name NEXEO SOLAR ONS 7.Transporter 2 Company Name U.S.EPA ID Number TEMARRY REt TtC- LING INC CAF,0001:34217 8.Designated Facility Name and Site Address U.S.EPA ID Number RECICLADORA TEMARRY DE M KIMX I C130619001 CARR FED #2Z MEX-TIJ, KK 121 TECATE BC 215:30 Facility's Phone: 665-655-1462 ga. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes HM and Packing Group(if any)) No. Type Quantity Wt.Nol. X 1. 601263, WAuTE PAIR' 3, II, K MOD, ERG 128, tiWT, T4Ri9-1fi:9 �J I z 2. W t7 - 3. 4. 14.Special Handling Instructions and Additional Information E»ergeney Phone: Chemtree 800-424-9300 C31811; 11198898(26)1 15. GENERATOR'S/OFFEROR'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, marked and labeled/placarded,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 Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a small quantity generator)is true. enerato s/Offeror's Printed/Typed Name Signature on ay ear ri 16.International Shipments , Import to U.S. ❑Export from U.S. Port of r try/exit: Z Transporter signature for exports only): Date leaving U.S.: W 17.Transporter Acknowledgment of Receipt of Materials Transporter 1 PrintedlTyped Name Month Day Year IL ym-17- aTransporter 2 Printed/Typed Name I.Sidnature Montin Day Year t- 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number J_ V Q �- Facility's Phone: W 18c.Signature of Alternate Facility(or Generator) Month Day Year a z 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) -404 1. 2. 3. 4. Ll20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Printed/Typed Name Signature Month Day Year EPA Form 8700-22(Rev.3-05) Previous editions are obsolete.