COMPLIANCE INFO_2019 - Laserfiche WebLink

Home Browse Search

Ploa,o print or type.(Farm designed for use on allte(12•plich)typewriter.) Form Approved.OMB No,2050.0032 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tmcldng Number WASTE MANIFEST CAD 9 819 6 7 6 8 0 1 (80Q)424-9300 017792427 JJ K 5.Generators Name andlrlailing Address Generators Site Address(If different than moiling addross) STOCKTON DODGE INC 3333 AUTO CENTER CIRCLE STOCKTON CA 95212 Ganorators Phone:. 209 477-3668 6.Tmnsportar 1 Company Name U.S.FPA ID Number ASBURY ENVIRONMENTAL SERVICES CAD 0 2 8 2 7 7 0 3 6 7.Transporter 2 Company Name U:S:EPA ID Number WORLDWIDE RECOVERY SYSTEM INC. CAR 0 0 01 7 5 4 2 2 8.Designated Facility Name and Sita Addross W � U.S.EPA ID Number YUMA YES LLC 2730 E 13TH ST YUMA AZ 85365 AZR000516924 Facility's Phone: ga. 9b.U.S.DOT Description(Including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit end Packing Group(if an Quantity WtNol. 13.Waste Codes HM 9 P� Y)) No. Type ry 0 1'NON-RCRA HAZARDOUS WASTE,SOLID(OILY SOLID,PAPER FILTERS) 3 qc5b� 352 DM P z 2, LU t9 3.. 4. 14.Specfat ard�ng Irr,}r KA=and Addilloral Inlormation W W EMERGENCY CONTACT:CHEMTREC 1-800-424-9300 WOES TERMINAL CERES CS *PROFILE#981:162623NRSST0627 OILY SOLID.PAPER FILTERS* *APPROPRIATE PERSONAL PROTECTIVE EQUIPMENT 15. GENERATOR'S10FFEWR'S CERI'll'iCATION:I hereby declare that the contents of this conskgnmontare fully and ac6urately described above by the limper shlppIrg•name and'are less ,packaged, marked and labeled/placarded',and are in all respects in proper condition for transport according to applicable intnmatlon nd nalloraf quommentat mgwa bons.If export shipment and I am,the Pdrhery Exporter,I Certfy,that the contents of this consignment conform to the terms of the attached EPAAdvrowiedgmant of I cedffy`that the waste mlpinlzadon statement Identified In 40 CFR 262.27(a)fd I am a large quardity goneraVx O quantity gvwralar)Is no, Gwxn, tLmcmes Rnrta&Typad Noma 5fgnabhr monih Day oar z _+ 16.Intemetonal Shipments r ❑Import to U.S. ❑Export from U.S. Port of'entry/exit Z Transporter slgnabrre(for exports only): Dale leaving U.S.: 17.TransporterAcknoWedgment ofRecoipt of Materials Tran«potter 1 Pdnt4drTyp d N � Sgnalura ldo J iy Y Transporter 2 PrintodfTyped Nam Signature Month Day Year ti- 18.Discrepancy 18a.Discrepancy Indlcation Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full ReJectlon Manitast Refomnca Number. 18b.Allomate Facility(or Generator) U.S.EPA ID Number J U c4+ Facllity's Phone: w 18c.Slgnaluro cfMlemato Faclily(or Generator) Month Day Yoaf Q z 19,Hazardous Waste Report Management Method Codes(I.a.,codes for hazardous waste treatment,disposal,and recycling systems) LU 1, 2 3. 4. 20.Designahed Facillty Owner or Operator:Certification of racolpl of hazardous materials covered by the manifest oxcopl as noted In Item 18a Printod/Typod tlamo Signature Month Day Year BPA Farm 8700.22(Pev.3.05) Previous editions are obsok�*,• DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED)