Laserfiche WebLink
F <br /> f <br /> NINA <br /> Please print or type.(Fort designed for use on elite{12-pitch)typewriter.) Form Approved.OMB W 2050-4039 <br /> UNIFORM HAZARDOUg 1.Ganeraler ID Number 2.Page 1 of 3.Emergency Response Phone 14.9anifestTrackIng Number <br /> 066 V UP <br /> 5:Gen tot s Na <br /> mo andMailingMdress . ATTN:Anthony Flores Generator's Silo Address(if different than mailing address) <br /> TracyUntited School Disldct- TUSD•-Mst High School <br /> 1ST 5-WLoWelf AVe 1775 W.towell Ave <br /> Tracy,CA Tracy,CA95376 <br /> Generalcu's Phone: 209-321-6215 <br /> 6:Transporter 1 Company Name U.S.FAA ID Number <br /> Ingenium (Secramenfo)("*"*ERI PHC)NE-CUstlD#r'8766-0004--) m600179747 <br /> 7.Trans Company Name U.S.€PAID Number <br /> Cleat!Hattors FnWonmental Services M4D039322250 <br /> 8.Designated Facility Name and Site Address U.S,EPA1D Number <br /> Clean Harbors Aragonite,LLC <br /> 11600 North . tuNoatl UTD981552177 <br /> Grantsville,LIT 84029 <br /> Facillly.5 Phone, 4355-884-8100 <br /> 9a- 9b.U,5.DOTDeseripli n(induding Proper Shipping Name,Hazard Class,10 Number, 10,Containers 11,Tata) 12 Unit <br /> HM and Packing Group(if any)) No, Type QuantityWtNoL 13.Waste Codes <br /> 0 1'Non-RCRAHazardous Waste Liquid(Specimens ln"l"ortn in) . 561 <br /> � <br /> 2.NA3077, Hazardous waste,solld,a.o,s."(salver,acetone},9,'Ili 352 D005 D011 <br /> X 'DOT ERG#171 <br /> 1 IJ� 70. F003 <br /> 4. <br /> i <br /> � 14.;;patialHandlingfnslardionsand Additional tnfa€natlan <br /> J" <br /> ©73046 SO 122911 <br /> •1)CH101S694 -2)CH818285 <br /> :Contiact.retauidd tiy:genenitor confers agency authority ania!qmeter to acid or substitute additicmal trar>S oAers ongeliamtoes behalf <br /> 15. GENMTOR'SIOFFEROR`S CERTIFICATION:I hereby declare that the contents of this consignment are fully and aoeuralefy described above by the timpershlppiriq name,and are classified.packaged, <br /> marked and fabeledfplacarded,and are in aff respects in proper condition for transport amDirding to applicable Inlomailonat and national governmental regulations.If export shipment and I am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terms of theattached EPAAcknorti 4ment of Consent. <br /> I csrtify that the waste mlnfmization statement Identified In 40 CFR 242.27(a)(if f am a large quantity generahu)or{b)Ra a8 ggardity genaralorj fs true, <br /> G OtierolsPdn Name Sigilahrm Month DayY ear. <br /> lntemat{ Ipments <br /> ❑lmporlfoU.S. ❑ExportfromU.S. PartaenlrylexE <br /> z iranspodersrgnahrre(rorexpodsanfy): <br /> Dale leaAng U.S.; <br /> 17.7ransporterArdmowledgmentof Receipt ofMatedafs <br /> fC Transporter 1 Printedlryped Name <br /> Signature <br /> -Month pay Year <br /> CL <br /> Q Trans der 2 Prinledlryped Name o <br /> a� r <br /> asprith <br /> I ft <br /> tfiscrepancy " " <br /> 18a.Discrepancyfndicayorispace ❑ Quantity <br /> Type El Residue ❑PadlafRejection ❑FuIIRe)e'ctlon <br /> Manifest ReferenwNumbec <br /> 18b.Nlemale Facility(or Generator) <br /> U.S.EPA ID Number <br /> to FadlitysPhonc:• <br /> 18c,Signature-ofAftemateFacility(or Genefator) Month pay - Year <br /> 1g.Hazardous Waste Report Management Method Codes(i.e.,Codes for hazardous waste treatment,dlsposa#,and reeding systems) ' <br /> 4. <br /> 20.Designaled FacilityC�vner or Operator.Cedfficatian of receipt of hazardous malenials covered by the manifest except as noted in Item 18a <br /> Pnntedrfy d.Natne Signature Month bay Y r <br /> aJJA <br /> EPA Form 8M-22(Nov 3-05) Previous editions are obsolete. <br /> DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />