Laserfiche WebLink
1189922 <br /> oral des red for use on elite 12 'c1t}typewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM IiAZARDOUS 1 1.Generator ID Number 2.Page 1 of I3.imerprcyiespofi-se-Phone 4.ManUeat raekkl Nwnber <br /> WASTE MANIFEST CAR 7239 ,2 (877 577-2669 0 0 7 52021 JJ K <br /> 5.Generatads Name and Malang Address NS Generelora SiInAddress(l dlfaraM than mI,g address) <br /> Boas Depot C/O FIX III Hoge Depot CSR 1101E DEPOT #HDi116 <br /> 5151 Sag Felipe 911 DEPOT #11111116 251 0011111113 Avg <br /> Gener TI 77156_J160311113-7.30 MTECA CA 95336 (2191825-9139 <br /> 8.Transporter 1 Company NameU.S.EPA ID Number <br /> 21St COY EMM AL MANA1 EHM OF CVs LLC 'C ARMI @12 <br /> 7 2ray amsU.S.EPA ID Number <br /> ft o o(x7q lu=:� <br /> 8.Designated Facility Name and Sae Address U.S.EPA ID Number <br /> GB11M IM101tR61TAL ROT, LLC DBA PSC 3"IROIDMAL BERYICES <br /> 11855 111!6 ROLL ROAD <br /> Factit Ills,Phone:1A1CH0 CORDDYA CA 95712 916 351-1911 CAD9 M84183 <br /> 9a. Ox U.S.DOT Desafplon(hduding Proper Skipping Name,Hazard Clew,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes <br /> HM and Faclda9 Glow(ti any)) No. Type Quaintly WLI <br /> 1 911951 WASTE WOMB, PLABWABLE 2.1 Dox-SP12842 19(0117=11) 11111 D115 N17 <br /> ,x Q® � w t�v 61 P - <br /> Dill D135 331 <br /> 2, x11993 xASTE Puma L199IOS, CO. (ACETODE, ofin KWL 11111 D135 331 <br /> 91TO11) 3 1911 (PLIMPOIDT=21.11C) 19(0111=111) ®p 1 w 00111 P ---- <br /> 3. <br /> X 4 11wimnVINTESWIFET - — <br /> 4. <br /> X <br /> 14.Wall Handling Instructions and Aildill Information x a3 t <br /> (1) Ht111E2.I-14 - ERG(126) LS-AC TIO (2) -14 - al ILUMIS L00SEPACt <br /> Y ID 8EF SAL#f <br /> 1 <br /> 15. GENERATORVOFFEROR'S CERTIFICATION:I hereby dedare that to contents of this consignment aro fully and accurately descritred above by the proper shipping Inane,aid are dasaw packaged, <br /> marked and latJetedlp)acarded,and are In as rasps*it proper condition for transport according to applicable Inienalond end national governmental regulations.If el shoot and I am the Primary <br /> Exporter.I carllfy that the.contenis of this consignment conform to the terms of the atfiI EPAAdmowladgmant of Consent. <br /> I cerfly that the waste minbrdzalon statement Idenalad In 40 CFR 282.27(a)(111 am a large qua*generator)or(b)(ll am a small quantity,generator)Is trace, <br /> General s Printedlrypad Namo Moll Day Yew <br /> o� Ib <br /> 8, al shipments ❑Import to U.S. <br /> pa Elxport .8. Pod of eMry/ezit: <br /> -- Transporter sI nakrra forexyorts only): Date leaving US., <br /> 17.Transporter Acknowledgment of Receipt of Mates <br /> Transporter 1 P yped Jtems Signal Mordtt Day Year <br /> A a-KN /2- G 11 1 -- letzi 2 to <br /> rmnsporter 2 PfinlaWyM Nam Signature Month Day Year <br /> 1a.Dxorr <br /> i8a,Discrepancy indication space ❑Quantity [:]Type ResWkce ❑Partial Refeclork ❑Ful Re}eoaon <br /> Ma fest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA 111 Ncnnber <br /> CJ <br /> Fadaty s Phone; <br /> ® 8a Nnallo Alternate Fad*(or Generator) <br /> Month Day Year <br /> a <br /> a . <br /> 19.Hazardous Waste Report Management Method Codes(.e„Codes for hazardous waste bealiftwill.dlspoad,and recycling systems) <br /> 1 11141 2' 3. 4. <br /> 11161 W141 8141 8141 <br /> 20-113asipateediFedlity,Dwrar or Operator,Certification of reoelpt of hazardous materials covered by the manifest except as noted In m 18a <br /> PIn ;( OV;3-05) <br /> Signature Day ear <br /> EPA Form 8700-2 . Previous editions are obsolete., <br /> DESIGNATED FACILITY TO STINATION STATE(IF REQUIRED) <br />