COMPLIANCE INFO_2020 - Laserfiche WebLink

Home Browse Search

Please pri J r type. Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number �, 2.Page 1 of 3.Emergency Response Phone 14.Manifest Tracking Number WASTE MANIFEST Ort r u 6-671-W47 020445970 t 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) JUJ BODY SI-#r� 000 CCtu I)GRv`E C#UIDIw O STOCKT -N,CA 9E-0j4 Generator's Phone, t -_. 6.Transporter 1 Company Name U.S.EPA ID Number RA,,W10G EN''eriRIDNINAEWA GlRR iAclm�3 INC, 7,Transporter 2 Company Name _ U3.EPA ID Number r � "'fir oc d 1 `5"�L.:11st) 8.Designated Facility Name and Site Addrepp.CIPI R StjLJJRCFE REGOVE-R}' U.S.EPA ID Numbs g3 LOS;ilt#GGL4„'a,CA 90023 Facility's Phonp3"4 ',71`5 9a. 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)) 13.Waste Codes No. Type Quantity Wt./Vol. o1. lJtril r6r SF A.J; t 4 t 1ffiI $art,.' i 3, ,f� III r� Z z. Y� CI?O W 3. 4. 14.Special Handling Instructions and Additional information 1` ffiC#d 'r r 1r.,ii 9S F-R. '60Ki f°cZTOiR: RADS ENVlRONHWEt_TA APPROkU0 PPE 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, 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 EPAAcknowiedgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if 1 am a large quantity generator)or(b)(ill am a.small quantity generator)is true. Generators/Offerors Printedlf Name ✓ 1g' ¢j / F &i9nature`� t r Month Day Year 16.International Shipments ! p j... ❑Import to U.S. ❑Export fr.-'6 S ` Port of e t�j/exit: Transporter signature(for exports only): Date I z4/exit: U.S.: W 17.Transporter Acknowledgment of Receipt of MaterialsUJI -- Transporter)/Pdnled/Typ}ed Na a - r Signature Month Day Year N fo ff r1 f '+r d �r�` J .T r�..--.r" /".l _ "- 1 1221 (� z Transpo erg Vned ype Nam _ e,Signatur ;X r s- r.� Month Day/- Yeat 18.Discrepancy 18a.Discrepancy Indication Space F] quantity, ❑Type ❑Residue f ❑Partial Rejection ❑Full Rejection Manifest Reference Number. 18b.Alternate Facility(or Generator) U.S.EPA ID Number J Facility's Phone: LU 18c.Signature of Alternate Facility(or Generator) Month Day Year Q Z 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) n 12. 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 81gnalury z Month Day, Year, . EPA Form 8700-22(Rev.12-17) Previous a itions are ob lete. I DESIGNATED FACILITY TO GERERATOR