COMPLIANCE INFO_2019 - Laserfiche WebLink

Home Browse Search

Please print or type. l Form Approved, OMB No, 2050-0039 UNIFORM HAZARDOUS 1 . Generator ID Number 2. Page 1 of 3. Emergency Response Phone 4. Manifest Tracking Number WASTE MANIFEST CAD981456023 2 800-633-8253 000247425 DAT 5. Generator's Name and Mailing Address ATTN : Mike Ubick . Generators Site Address (if different than mailing address) University Of The Pacific University Of The Pacific 3601 Pacific Ave 3601 Pacific Ave Stockton , CA 95211 Stockton , CA95211 Generator's Phone: 209-946-2908 6. Transporter 1 Company Name U.S. EPA ID Number In enium Sacramento ** ** ERI PHONE-Gust ID# 8766-0004** ** CAR000179747 7. Transporter 2 Company Name U.S. EPA ID Number Ingenium (Milpitas )(*** "ERI PHONE-Gust ID# 8766-0002* ** *) CAR000179747 B. Designated Facility Name and Site Address U.S. EPA ID Number Recicladora Temarryde Mexico , SAde CV MXC130619001 Carr. Fed . No, 2, Mex-Tij , KM 121 San Pablo Tecate, BC , Mexico , CP21530 Facility's Phone: 619-270-9453 Chemtree 2417 # EMERGENCY (800) 424-9300 ga. 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10, Containers 11 . Total 12. Unit 13. Waste Codes HM and Packing Group (if any)) No. Type Quantity Wt.Nol, 0 1 ' UN19931 Waste Flammable liquids , n .o .s.. {ethanol, toluene), 3 , II D001 F003 005 X DOTERG# 128 © © A bf, Q 100 331 L2' NA3077, Hazardous waste , solid , n .o .s . (lead nitrate , methanol), 9 , D006 D007 D008 X III DOT ERG#171 O o C;F 19 0 F003 F005 352 3. 4. 14. Special Handling Instructions and Additional Information D90971 SO 169203 , 1 ) R18-21060 2) R18 -21062 `yXG`!g) p� H � Primary Exporter:TemarryRecycting, lnc. AOC Solvent 020514 E18001 Aqueous 020526 El 8001 Solid 020530 E1800 15. GENERATO 'SIO FEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name, arca are classified; packaged, marked and labeled/placarded, and are in all respects in proper condition for transport according to applicable intemationaland 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 EPA Acknowledgment of Consent. 1 certify that the waste minimization statement identified in 40 CFR 262.27(a) (if I am it large 'quantity generator) or (b) (ifI am a small quant( generator) is true. Generators/Offerors Pdnted/T d Name so Oda Month Day Year 64t mau� ) 0 � © 16. Int mational Shipments F ❑ Import to U.S. Export from U.S. Port of entry/exit: 2S ? Transporter signature (for exports only): Date leaving U.S.: W 17. TransporterAcknowledgment of Receipt of Materials LLJ Transporter) Printed/Typed Name Signature Month Day Year IL LLt Z Transporter 2 Printed/Typed Name Signature Month Day Year Y F 18. Discrepancy 18a. Discrepancy Indication Space ❑ Quantity ❑ Type ❑ Residue ❑ Partial Rejection ❑ Full Rejection Manifest Reference Number: 18b. Alternate Facility (or Generator) U.S. EPA ID Number J V LL Facilill/s Phone: w 18c. Signature of Alternate Facility (or Generator) Month Day Year Q Z y19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) 1 . 2, 3. 4, 20. Designated Facility Owner or Operator. Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a PrintedlTyped Name Signature Month Day Year EPA Form 8700-22 (Rev. 12-17) Previous editions are obsolete . DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM