Laserfiche WebLink
Form Approved,OMB No.2050-DO39 <br /> Please print or type. <br /> UNIFORM HAZARDOUS I.Generator 10 Numtser 2.Page 1� 3.Emergency Response Phone 14,"��13 x31Number 5 9 6 4 F L E <br /> WASTE MANIFEST { 8204 '� BBB-7&7225 <br /> 5-Generator's Name and Mailing Address Generator's site Address(if different than mailing address) <br /> Califnmia Natural Products <br /> lLathrop ashlynn.;amin@cnp.com <br /> Generators Phone: Us.EPA Ip Number <br /> 6.Transporter 1 Company Name CAROO 70W <br /> AdwjvDed Chemical Transport kr../DBA AGTenuro <br /> U.S.EPA ID Number <br /> 7,Transporter 2 Co my�ny Name CARD0017542.2 <br /> World4def Qoltti'xy System, Inc <br /> 8-designated Facility Name and Site Address U.S.EPA ID Number <br /> Yuma YES, LLG AZRO10515924 <br /> 2730 E. 13th St <br /> Yuma, AZ 85.85 <br /> Facilis Phone: 9m-��8 <br /> ya 96.U-S.DOT Descnption(inducing Proper Shipping Name,Hazard Class.ID Number, 16.Containers 11,Total 2-U:ut 13•Waste Codes <br /> HM and Padang Group(lf any)) No. Type 4uantity 4vi.,'Vol. <br /> I-Non-RCRA Hazardous Waste,Ligtrid,(Coolant,Anfifreeze) DM }� p 135 <br /> a f 1 <br /> w <br /> z. <br /> � f <br /> 3. <br /> 4, <br /> 14.Special Handling Instructions and Additional lnformation Prpjed Number 233579 ❑oc;d ent D281 W <br /> 1) 176708 GAY- c]a <br /> i�1 S <br /> 15. GENERATORVOFFEROR'S CERTIFICATION'. I hereby declare that the contents of this consignment are(ally and accurately described above by the proper shipping name,and are classified,packaged, <br /> marked and Iabeledlplacarded.and are in all respects in proper c andition for transport according to applicable international and national governmental regulations.If export shipment and I am the Primary <br /> Exporter,I certify that the contents of chis consignment nonfarm to Ute terms of the attactied EPA Acknowledgment 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)iii am a small quantity generator)is Ince. <br /> GeneratorsfOfferor's Printed(( me Signature Month Day Year <br /> ! I 1c.) zr) <br /> w 16-International Shipments ElImpa1 to U.S, ❑ xporf from U.5- Part of entrylexit: <br /> Transporter signature(for exports only): <br /> Date leaving U.S. <br /> W 17.Transporter Acknowledgment of Receipt of Materials <br /> Signature IMonth Day Year <br /> Transporter 1 Pri t y me / 3a <br /> I der a .� <br /> Year <br /> 7Mnsporler 2 PnntedrTyped Name Signature Month Day j <br /> 2 <br /> 18.Discrapancy <br /> 18a.Discrepancy Indication Space Q.tity ❑Type ❑Rasidue ❑Partial Rejection ❑Full Rejecihon <br /> Manifest Reference Number. <br /> 18b,Alternate Fatality(or Generator) U-S-EPA ID Number <br /> J_ <br /> Facitily's Phone: Month Day Year <br /> LLj 18c.4nature of Ntemate Facility(or Generator) <br /> a <br /> x <br /> S2 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> a 1 2• 3. 4, <br /> t✓� <br /> 20-Designated Facility Owner or operator.Certification of receipt of hazardous mstonals covered by the manifest except as AqW in Item 18a <br /> Pnnted+Typed Mame,b Signature Month pay 15Year <br /> j-,cA a cAt/C4 YLA- -.th Az-4v- <br /> D- 111) <br /> EPA Form 8700-22(Rev.12-17) Previous ecilbons are obsolete. DES]G&TTEVFACILITY TO EPKs e•MANIFEST SYSTEM <br />