COMPLIANCE INFO_2020 - Laserfiche WebLink

Home Browse Search

Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 a UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phoneanifest Tracking Number 4.M WASTE MANIFEST J J K 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) H Ntf.RWE r.: . 401 14 SAF4-JOSE ST STOCI OA 96 Generator's Phone: 6.Transporter 1 Company Name" U.S.EPA ID Number 'ER, CES INC' 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address U.S.EPA ID Number 311'50 FEAST PICC"LVD. +�#7EIOB7t� i LOG ANGELFS,CIA 1'00,23 Facility's Phone: ga. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit HM and Packing Group(if any)) No. Type Quantity Wt.Nol. 13.Waste Codes 1 9t f,:.r:.633 `+�1♦«.4. -:.'J-i,�i!dC ,+'�'t:Plf O Z 2. W 3. R 4. 14.Special Handling Instructions and Additional Information �.� c�IrrT� r �,. �fv'wfll�ur�In�fEa�Tal. 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 EPA Acknowledgment 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. Generator's/Offeror's Printed/Typed Name Signature Month Day Year J 16.1htemational Shipments F- ❑Import to U.S. ❑Export from U.S. Port of entry/exit: Z Transporter signature(for exports only): Date leaving U.S.: W 17.Transporter Acknowledgment of Receipt of Materials l'- 1 Printed/Typed Name Signature Month Day Year N QTransporter 2 Printed/Typed Name Signature �. Month Day Year 18.Discrepancy ' 18a.Discrepancy Indication Space ❑ Quantity El Type 0 Residue El Partial Rejection ❑Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number _J V LL Facility's Phone: W 18c.Signature of Alternate Facility(or Generator) Month Day Year r -7r 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 0 1. 2. 3. 4. 20.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.