Laserfiche WebLink
i <br /> Please 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 <br /> WASTE MANIFEST GAM41652&M 1 '216437l .V47 020390938 JJ K <br /> 5. Generator's Name and Mailing AddressGene�tors Site Address (if different than mailing address) <br /> CAMPBEi1 . S�UUP- � � c vn � t A � yF t. C <br /> 60 INDUSTMAL. M <br /> STOCKTON , CR. 9152% <br /> Generators Phon&30� 2151-3�`s9 <br /> 6. Transporter 1 Company Name U.S. EPA ID Number <br /> RHMO - EFRJIROMMEUTAL SERVICES INC . C.A0044GG955b <br /> 7. Transporter 2 Company Name U.S. EPA ID Number <br /> 8. Designated Facility Name and Site Address VEOL W ES TE CFMdIC 4L SCA .i rTIOW; U.S. EPA ID Number <br /> 1126 HENSLEY STT FT GATO4"ltldf)7r! <br /> RICHMOM , CA 9AW1 <br /> Facility's Phone:°U� <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 WI.Nol. <br /> 1 . IXW77 V WASTE ENL/rDFOX 1t_NT/+ t ' ' AAC)CrUS 9UBST� NC' ES .fE* . P iA1 on <br /> 0 SOLID , f4pc: , 9 • PGIII (MIAI_ S}{A\ 04k:i ' - 1 GIiRC"W..)M) i ( 't 1 �i rt,• F' k <br /> mL <br /> W 2 <br /> 3. <br /> 4. 1 <br /> 14. Special Handling Instructions andAddiUonal Information C r^ <br /> 9✓H1 �ROPft. [-:r; EF�i#17 f £ . a6 <br /> 114801 ERS Tr} HE TRAIrIEO AND USE APPROVED PPE <br /> ' R CCNdTRACFOR : RAMOS; E%MRONMENT.AI SERVICES C, 07 _ / X ,a <br /> 15. OENERATOR'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 governments] 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 EPAAcknowtedgment 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) (ifI am a small quantity generator) is true. <br /> Generators/08erors Printed/Typed Name d Sfoature r Month Day Year <br /> ;., r: Z• r t j r"` 7' <br /> � 116. International Shipmentsr <br /> El import to U.S. ❑ Export from U.S. Port of entry/exit <br /> 9 Transporter signature (for exports only): Dale leaving U.S.: <br /> W 17. Transporter Acknowledgment of Receipt of Materials <br /> Transporter 1 Printed/Typed Name, Signature _, - Month Day Year <br /> a <br /> Z Transporter 2 PdntedlTyped Name Signature Month Day Year <br /> f- <br /> 18. Discrepancy <br /> 18a. Discrepancy Indication Space ❑ Quantity ❑ Type ❑ Residue ❑ Partial Rejection ❑ Full Rejection <br /> Manifest Reference Number. <br /> 18b. Alternate Facility (or Generator) U.S. EPA ID Number <br /> J_ <br /> V <br /> LL Facility's Phone: <br /> W 18c. Signature of Alternate Facility (or Generator) Month Day Year <br /> a <br /> z <br /> y19. Hazardous Waste Report Management Method Codes (i.e„ codes for hazardous waste treatment, disposal, and recycling systems) <br /> 0 1 . 2. 3. 4, <br /> 20, Designated Facility Owner or Operator: Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Printedrryped Name Signature Month Day Year <br /> EPA Form 8700-22 (Rev. 12-17) Previous editions are obsolete. GENERATOR' S INITIAL COPY <br />