Laserfiche WebLink
C <br />Plaasa mint or tune. (Form desk for use an elite (12-oitchl hmewritecl <br />• . <br />. Form ADDmved. OMB No. 2050-0039 <br />EPA Form 8700-22 (Rev. 3-05) Prey editions are obsolete. DESI 1'i Y TOESTINATION STATE (IF REQUIRED) <br />11 10372.0083 <br />UNIFORM HAZARDOUS <br />[PenersiorlDNumbor <br />2. Page 1 of <br />3. Ernargemy Response Phone T4*.Mwtftt <br />Tracking Nuber <br />-003239983 JJ <br />WASTE MANIFEST <br />CAU235NO13 <br />, <br />5. Generators Norm and MaMN Address CkmeraWs Site Address (d different than mailing address) <br />SUMMT LOGISTICS,4SAFEWAY) <br />16900 WEST E RD. <br />TRACY, CA 95377 <br />Gerreralor's Phone: XMFMACM <br />6. Transporter 1 Company Name U.S. EPA ID Number <br />SHOP RAZARDS SOLUTIONS CM0MG497 <br />7. Transporter 2 Company Name U.S. EPA ID Nnmmbet <br />8. Designated Farddy Name and Site Address U.S. EPA ID Number <br />HO CORDOVA. LLC. CAD9808941 B3 <br />11 @55 WHTE ROCK RD. <br />HO CORDOVA. CA 95742 <br />Fad sPhorne: 948'351-Q9® <br />ga. <br />9b. U.S. DOT Description (including Proper Slipping 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 Padang Group (d 810 <br />Quantity <br />Wt.Nol. <br />WASTE SOLD. <br />1 N 4R <br />1W <br />P <br />223 <br />352 <br />THAZARDOUS S 8 OIL <br />. <br />Z <br />2. <br />us <br />c7 <br />3. <br />4. <br />14. Special Handling Instructions and Additional Information <br />PRORLE#R21791. <br />APPROPRIATE PROTECTIVE CLOTHING <br />SEE ERG #171 <br />15. GENERATOR'S/OFFERORS CERTIFICATION: I hereby declare that Bre contents of this cons"ent are fully and accurately described above by the proper shipping name, and are dassifed, <br />marked and labeladoacarded, and are in all respects in proper condition for transport aeeordirg to applicable international and national govemnwnfal ns. 9expot shipment and I ern ft Primary <br />Exporter. I certify that the contents of Cris consignment conform to the terns of the attached EPA of <br />I certify Mtlhe waste i in 40 CFR 262.27(a) (d t am a large quantity ge r) or (b) I a small g is <br />Ge (?rinteff d Name re ` - Month Day Year <br />LZ2 12 <br />_a <br />16. IrMalmV Shipments ❑ Import to U.S. ❑ Export 7 Pot of entry/exit <br />Transporter leaving U.S.: <br />Transporter signature (for exports on <br />17. Thimsporter Acknowledgment of Receipt of Materials <br />Transporter 1 rped Name Slgnatwe Nbntin Day Ye <br />... <br />rernspaler 2 Name re Month Day Yew <br />18. Discrepancy <br />18a. Discrepancy Indication Space ® Quantity ❑ Type ❑Residue Partici Rejection ❑ Fu9 Rejection <br />Manifest Reference Number. <br />18b. Mtsmate Facility (or Generator) U.S. EPA ID Number <br />Vf <br />FacMtys Phare: <br />18c. Signore of Alternate Facility (o GenersM <br />Month Day Year <br />H19. <br />Hazardous Waste Report Management Method Codas (Le.. codes for hazard wash haftK disposal, and recycling systems) <br />® <br />1. <br />2. 3. <br />4. <br />20. Designated Fa I Owner or Operator Certification of receipt of hazardous materials covered by the manifest except as n Item 18a <br />11 <br />lure <br />EPA Form 8700-22 (Rev. 3-05) Prey editions are obsolete. DESI 1'i Y TOESTINATION STATE (IF REQUIRED) <br />11 10372.0083 <br />