Laserfiche WebLink
Please AIN010=1111 <br /> print or .(Form designed for use on elite(12-plt)typewriter.) ER _ Form Approved.OM®No.2o50-0D39 <br /> UNIFORM HAZARDOUS 1• ro 2. 1 3.E Pham 4 MarffeatTradrkhg <br /> WASTE MANIFEST CA 29732 2; 011434102 F L <br /> 5.Generatoft Nam and s (ti dbwt that malting ) <br /> US #3908CVS#03908 <br /> 2098362300 1885 West 11th Street 1885 West 11th Street <br /> GerrersbA Phone.. Tracy. :,.CA 95376: Tracy, CA 95376 . <br /> 6.Transporter I MWF&�w U.S.EPA ID Number <br /> Stericycle Specialty Waste Solutions Inc NNSM118924 <br /> 7.Trarrsponer 2 Company Name U.S.EPA ID Number <br /> ite mea 21st Century EM, EEC U.S.EPA 10 Number <br /> 2095 Newlands Dr. East <br /> Fernley, NV 89408 <br /> F.da ph,,: 7755752760 NVD980895338 <br /> ga. 9b.U.S.DOT DescrOw(mcluding Prow ShIppIng Name.Heard Class,D 10• 11.Tofal 12.Unit 13.Waste Codes <br /> MM and Packing Group(If any)) No. Type Quarwly WtNd. <br /> —rtLKJL953j. s 2.1, <br /> EKGNT?E� E BR, 811IM6 P7— 214 DOM,O <br /> w X 2UN28119 ase Toxic so is, organic, n.o.s. 12 P 31 P001 P075 <br /> (Warfarin, Nicotine), 6.1, PG II, E 154 <br /> X 3UN3266, Waste Corrosive liquid, basic, ! CF 00018 P 121 D002 <br /> inorganic, noo.s. (Sodium Hydroxide, <br /> ftf!'assium Carbonate), B. 08 T1. ERSAIM <br /> X 4UN1993, Waste Flameable liquids, n.o.s 1 BA• lbam P 21D001 LOW <br /> (Alcohols, Acetone), 31 PS II, ERG#128 <br /> 14.SpecteMmiftinstrucUorts and Addillorral Inkrundom 1.PKG-DFn 1 l(Aeroso:.l.s,. Flannable) 2. 1 05(Acute Toxic <br /> Soli.ds)• 3. 100199(Carrosive Basic Liquids) 4.PKG-DFe100198(Flammable Liquids) <br /> 15. GENERATOR FEROR%CERTIFICATION: I hereby dedare that the contents of this consigmreM are"arid accurately described abme by the proper shipping name,and are dassilled, <br /> marked and latreWplacairded,and are in all respects in proper condillon for transport according to applicable Internatlomill and national govemmental regulatim.If export shipment and I am the Primary <br /> I certify that to contents of he consignment conform to the tams of ft EPAAdmowledgment d Consent. <br /> I oetify that the waste mifilmiatlon stalamert klentilied in 40 CFR 26227(a)(d I am a large gramtity germatorl or(b)(d I am a small qjareity gmerator)is true. <br /> GervabVVIeror's aha SV Mwth Day Year <br /> XM <br /> 16.Interrretiorml Shipments Import toU.S: i <br /> ❑Export from U.S. Port of xit <br /> T for onl : Dai LeN U.S.: <br /> M 17.TrareporlarAclarowledgmerit dRao*d Materials <br /> Trimsporler 1 Prfn me Signature Day <br /> Isidro Martinez 1 071 05 2001 <br /> T 2 <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑Quantity ❑Type ❑Reser ❑Partial ❑Fug Re)W, <br /> Manifest Rellarenge Number: <br /> 18b.Agemale Faddy(or Generator) U.S.EPA ID Number <br /> v <br /> Farbs Phare: <br /> 1 ec. • d Alternate Facility(a General Month Day Ya r <br /> 19.Hanrdcus Waste Report Mariagamerd Method Codes(i.e.,cods for heardoA waste treatment dWosd,and recycling systems) <br /> Gi. \J 2. 3. � 4. <br /> 20.Designated Facility Owner or Opera:Cer9catd receipt d ma covered by tta mangy except as nom in Item Ise <br /> PrinladfTyped Name, 'nature Mb Yea <br /> l <br /> EPA Farm 8700-22(Rev.3.05) Previous editions are obsolete. DESIGNATED FACII-Iry DESTINATION STATE(IF REQUIRED) <br /> 8 0Q1-.22 a2u�'- 2 ! 1 1,.SW76.- - 041149 w. M _ _.. .-VID270518 _._SD070518. <br />