Laserfiche WebLink
print or type. Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2,Page 1 of 3.Emergency Response Phone 4 Manifest Tracking Number p <br /> WASTE MANIFEST t;AL..tl!,03503�'t7 j 209-522-3271 . 0: `LL� G D <br /> 5.Generator's Name and Mailing Address Generators Site Address(if different than mailing address) <br /> JM EQUIPMENT CO,-MANTECA <br /> 321 SPRECKELSAV ., <br /> MANTECA,CA 95336 <br /> :Gene toes Phon�.09-522-3271-10 c ') J <br />! 6.Transporter 1 Company Name U.S.EPA ID Number <br /> i AMERICAN VALLEYWASTE OIL, INC. - CAR000272302 <br /> 7.Transporter Company Name U.S.EPA ID Number <br /> 'WORLDWIDE RECOVERY SYSTEMS INC CZAR 175422 <br /> 8:Designated Facility Name and Site Address U.S.EPA ID Number <br /> t 1..iMA V r _13 I j.C; <br /> 2730 E. 13THS i <br /> �1 F; tJl9754 <br /> YUMA,-? 235305 <br /> Facility's PhohX8-642-891313 <br /> ga. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes <br /> HM and Packing Group(if any)) No. Type Quantity Wt.N01. <br /> Qix 1' BION-RCRA HA7-ARL'1C1t+-1c;WASTE SOLID,, 8S0R8FPJTS&OIL, DTVI �00 la 351 � <br /> w <br /> t7 f <br /> i <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional Information <br /> PROFILE0162874NRS ABCAORBEN S&OIL ERG#171 <br /> EMERGENCY C(aKTAC.T° ROY <br /> 15. GENERATOR'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 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 <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment 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 /> GeneralVifferor's Printed/Typede Signature Month Dayi.QYear <br /> V en yt " ,r?t� � 7 _.!' fix' I ' <br /> J 16.International Shipments <br /> ❑Import to U.S. ❑Export from U.S. Port of entlexit: <br /> Z— Transporter signature(for exports only): Date leaving U.S.: <br /> LU <br /> 17.TransporterAcknowiedgment of Receipt of Materials <br /> Transporter 1 PriAt yptl Na e?, �,. Signatu� -N "® 5� Month Day, Ye <br /> CL <br /> z Tr portPrmted/Typed Namep' <br /> •--g'ignature M nth Day Year <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑Type <br /> Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> _i <br /> U <br /> der- Facility's Phone: <br /> C3 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> 19.Hazardous Waste Report Management Meihod Codes(i.e.,codes for hazardous waste Treatment,disposal,and recycling systems) <br /> ® 1. )� � � � 2. 3. 4. <br /> 20.Desi fed Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest�.Cdbpt as noted in Item 18 <br /> Pfintedl,Typ$d Name i{ Signa re4(j n Month <br /> Day Year <br /> �./ _. �`y iJ d i l,\1 <br /> EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. ! a' DESIGNATED ' 1I1�� GER <br /> TO 0- <br /> ;,. <br />