Laserfiche WebLink
CC V D <br /> Please pint or!!ve (Fom1 Best ned for Use on elite(12-pitch)typevmter.) Form Approved OMS No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generatoi ID Number 2.Page 1 of 3.Emergeneyl Response Phone 4.ManfhstTracckiing Number <br /> WASTE MANIFEST CA2890090002 a 925-a'23-4205 1005871010 JJK <br /> 5.Generates Naam�e and Ma Address Generator's Site Address(if different than mai sng addws <br /> LgarrarrGs lry�ratprr ifacltinal Ears^ratmry it tr 1130 To N"15.A Lawrzm= V <br /> 113.0 Pox ED?f L-796bv-imam CA 94551 t o ra Ho to R <br /> Generators Phone: 925-422-1925 AT TN N Shipp rig <br /> 6.Transporter 1 Company Name US.EPA ID Number <br /> Cie-an Harbors Environmemal Services Inc. MAD0393222SO <br /> 7 Transpoter 2 Company Name US EPA ID Number <br /> S.Designated Facility Name and Site Address U.S EPA ID Number <br /> Ciean Nar bc-,rs WilmingWn LLC <br /> 1727 L Oennt Street Wi m ngtsn CA 9074,4 <br /> Facili s Phone. 310-235 9992 <br /> gat 9b.U,S DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Conlalners 41.Total 12,Unit 13.Waste Callas <br /> Hht and Packing Group(d any)) No. Type Ouantity wt.Not, <br /> a 1 ton-RCRA hazardous waste,ltqutd f USED OIL)DGP001511 i <br /> 0 <br /> 221 <br /> Uj 2 h-on-9C1RA hazardouswasre liquid(ILISED Oil,)WP0QaG-1 DM 35. c <br /> ?2� <br /> 3 <br /> 4_ ` <br /> 14 Special Handsng nstnrctions and Additional Information <br /> Emergency Response Phone 925-423-4205 onta n me LILNL En egen-} tP Cn - <br /> l etfi�tif'iLe-rek-asenumbttr L a c OZe Z r my t,.: 5 a a E r n a <br /> 15, GENER4TOR'SIOFFEROR'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, <br /> marked and labeledlptacarded,and are in all respects in proper condition for transport according to applicable international and national governmental regu!alions.If export shipment and I am the Primary <br /> Exporter,I ceriity that the contents of this consignment conform to the terms of the attached EPAAcknrn+Aedgment of Consent. <br /> 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. <br /> Generator's;Offeroes PrintedlTyped Name SignaW Month Day Year <br /> Bradley 5lininger, an behalf of NNSA � �, C)y (, 1 of <br /> 15.International Shipments ❑ ❑ / <br /> Import to U.S. Export from U,S. Port of eritrylexit: <br /> Z Transporter signature(for exports only): Date leaving U.S.: <br /> w 17 Transporter Acknowledgment of Receipt of Materials <br /> Transporter 1 Pnnted?yped Name' S g,ature r Month Day Year <br /> 0 f � <br /> as Transporter 2 PdntedrTyped Name' - /r Signatu-re - w l` Month Day Year <br /> F <br /> 18.Discrepancy f�I <br /> 71 <br /> 18a.Discrepancylndicaron Spacce � tya-�«-- --..©Type <br /> Manifest Re!erence Nur-:er <br /> 18b Alternate Faahty(or Generator) U.S EPA ID Number <br /> J_ <br /> G� <br /> Facilty's Phone: <br /> uj 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> a <br /> a <br /> N19.Hazardous Waste Report Management Method Codes(i.e..codes for hazardous waste treatment,disposal,and recycling systems) <br /> LIJ G 1 2. 3. 4 <br /> -r i «.I I+-tl <br /> 20,Designated Facility Oxner or Operator.Certification of receipt of hazardous materials covered by Use manifest except as noted in Item 18a <br /> Print_ yped Name 4 i k T r3 r j m ` (— Signature Monde Dayl Y2 r f <br /> EPA Form 8700-22(Rev 3-0 5) Previous e&lons are obsolete, DESIGNATED FACILITY TO GENERATOR <br />