|
�okq
<br /> Please print or type,(Form designed for use on elite 12-piton typewriter.) Form Approved.OMB No.2050-0039
<br /> UNIFORM HAZARDOUS 1,Generator ID Number 2.Page i of 3,Emergency Response Phone 14,M.Ifest Tracking Number
<br /> WASTE MANIFEST C A L 0 0 ,0 3 4 1 1' 7 9 1 800 424-9300 0 J.90 5 9 3 a2,-1 JJ
<br /> 5, a raIn Name anc�141aifin Add Generator's Site Address(if different thart quilling address)
<br /> { TERN TRUtF NTER WESTERN 1"ELECIC,CENTER
<br /> PO>BOX 32020 3333 S. HIGHWAY 99
<br /> STOCKTON ICA 95213 ,- STOCKTON,CA 95215
<br /> Generator's Phone: ,2 0 '9� k' 3,2 3 -,,;7 30-0=
<br /> s0=
<br /> 6.Transporter 1 Company Nanta U.S,EPA ID Number
<br /> FRENIOUW ENVIRONMENTAL SERVICES INC C A R 0 0 0-1 7 1 0 1 7
<br /> 7.Tfanspoftr 2 Company Name U.S.EPA ID Ntmfber
<br /> WORLDWIDE RECOVERY SYSTEM INC C A R 0,0 0 z 1. 7 5 4 2 2
<br /> 8, e n e Fa iii e d dile Address U.S,EPA ID Number
<br /> �S��OEt� IAC ,
<br /> HWY 95,11 MI,S OF CY 16 ACRES
<br /> BEATTY NV,89003 .
<br /> Facilit's Phone: 775 553-2203 N V-T 3,,0-..0.11 0 0 0 0
<br /> 9a 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,NOI.
<br /> 1•NON-RCRA HAZARDOUS WASTE, LIQUIDS(OILY WATER): 223
<br /> W 2,
<br /> 4
<br /> 1. f
<br /> r
<br /> 3,
<br /> w
<br /> 0
<br /> 14.specl�iHsndfinglosuuelionsand Addifidnalinforltaun SG0701 1570-9061 Oily WaterERG#1;71
<br /> 1"�� C,).o 72 / 9- 9
<br /> HANDLERS TORE 40HR TRAUiFD AND.USE PPE.:>ER Contract#205907
<br /> 15, GENERATOR'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 labeledlplacarded,and are in all respects In proper condition for transport according to applicable international and national governmental 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 EPAAcknowledgment of Consent.
<br /> I certify that the waste minimization statement identified in 40 CFR 262,27(a)(if I am o large quantity generator)or(b)(if I am a small quantity generator)is true,
<br /> eseOffames Printed/Typed Si Month Day Year
<br /> ayll
<br /> —j 16,International Shipments
<br /> i— ❑Import to U.S, LJ Export from U.S. Port of entry/exit:
<br /> Transporter signature(for exports only): Date leaving U,S.:
<br /> WL 17,Transporter Acknowledgment of Receipt of Materials
<br /> Transporter 1'PrintedlType ame Slg:ralu Month Day Year
<br /> 1*4 OW—
<br /> CL
<br /> Transporter 2 Printedtrypeme Signe tre Mo 1t Oay Year
<br /> L4 'C-1 %
<br /> 18,Discrepancy
<br /> 18a.,Discrepancy Indication Space ❑ Quantity ❑Type f—�
<br /> e ❑Residue ❑Partial Rejection El Full Rejection
<br /> Manifest Reference Number.
<br /> 18b,Alternate Facility(or Generator) U,S.EPA ID Number
<br /> J
<br /> U
<br /> tai Facility's Phone:
<br /> w 18c.Signature of Alternate Facility(or Generator) Month Day Year
<br /> Q _
<br /> Z
<br /> N
<br /> 19,Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems)
<br /> or20;DA1gXtdai%,
<br /> ", 3. 4.
<br /> Owner or Operator.Certification of receipt of hazardous materials covered by the manifest except as not 'n lie
<br /> I t r11Qj W !A Prime a atn m 5iprtaturo Ht Day Years
<br /> 1
<br /> EPA Form 8700-22(Re 06) Previous editi s are obsolete. D SI+3NA IL.ITY TO DESTINATION STATE(IF REQU6 )
<br />
|