Laserfiche WebLink
rn <br /> C0 <br /> co N <br /> L _ <br /> CD f� <br /> lY r <br /> I Reeding•sl.*w•Wait 6eaameefo - O <br /> j � -....,nal Health DePa�ment � <br /> O <br /> U <br /> U <br /> rr <br /> Plea=310, <br /> ad or use on stile(12-pitch Iypewnl.r.) For. proved,OMB No.2050-0039 <br /> anerolnr ID Numher 2 PJO�. •A 9 En,mpm,r v M.pon.Phan. 1 u erlajaBFr�: NU U3 JJK <br /> 5 efi9u`!pri YFre—yl Ma In Ge rain(,Snn Address Ifdtlereid then meting addreee) <br /> r �..,I fr q Andre; •nei r k i,tN(RI CK CENTER <br /> - <br /> HIGHWAY99 <br /> Si'' '.KTgN T-A 9,215 <br /> Generamrs Phci., <br /> 6,mahn�e I C,rn,l`nnv Nine, U.S.EPAID Nurr&, <br /> FR.:.1'. CAROu <br /> 7.Trenep rler:,nn,pnn,Nnnn. U.S.EPA 10 Number <br /> dress U.S.EPA ID Number <br /> Fmili Is phone: <br /> go 96.11,OCT Description(including Proper Shipping Name,Hazard Class.ID Number, 10.Containers 11.Total 12.Unit 19 Wasto Cod. <br /> HA1 and Packing Group lit any11 No Type Quantity WI o1ol. <br /> fid <br /> K <br /> O <br /> Q <br /> K <br /> w <br /> Z <br /> W <br /> I I h1S WASTE STREAM HAS REE!'!OVA1IFIED <br /> AT'H'- <br /> CALIFORNIA. <br /> HECALIFORNIA.THt" `,' <br /> RMfTSTflRECEfIL`,'I)J;lt'I-il _31 REAM AS <br /> QUALIFIED.OUR EPA fJU(ui3ER IS GATO80013352 <br /> 1d.Special Handling Instructions and Additional Information2�1 '.ihilll!f!:. - <br /> > J Lf F A(e.7 UfA-1 FiAND(PR9 TO 8E AOHIi'IF-AINt+�'1.4ND VSE PP£ F7l('071t!?x.' <br /> .0 15 GENERATOR'SIOFFEROR'SCERTIFICATION:I hereby declare that the contents of this consignment are fully and accurately described ahove by the proper shipping name,and are classified,packaged. <br /> .marked and Iabelediplacorded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations.It export shipment and I am the Pmnaly <br /> Exporter,I certify that the contents of this consignment wnfam to the terms of the attached EPA Acknowledgment of ConsentCZ , enfi ty q W <br /> O I cemly that the waste minimization statement identified in 40 CFR 262.27(a)(if 1 am a large quantity generator)or(b)(If I am a small qu enerator)is e. Bnl),a.y.,DayYear <br /> Genemlorsi0demr's Pnnted(Typed Name Sgr,ature <br /> 16.Inlemational Shipments ❑Import to U.S, ❑Export from U.S. Pon of en0yexit. <br /> O Data leaving U.S.. <br /> O Transporter signature(for exports only): <br /> —0 rr 17.Transporter Acknowledgment of Receipt of Materials Year <br /> SignatureTransporter 1 Pnnledrryped NameO <br /> YearyO GTransponer2 Prntetl/fypetl Name <br /> -0 LL— <br /> N r <br /> CZ 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ivor; ❑Residue LJ Partial Rejection ElFaRejection <br /> •O ❑Quantity <br /> Manifest Reference Number. <br /> U.S.EPA ID Number <br /> 18b.Alternate Facility(or Generator) <br /> (Y� J <br /> O U <br /> Facty's Phone: Month Day Year <br /> LO <br /> O , 18c.Signature uAltemale Facility(or Generator) <br /> O Il- a <br /> N _ <br /> L0 ad, 19.Hazardous Waste Report Management Method Codes(ie.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 3. <br /> 20.Designated Facility Owner or Operator.Cedihcation of receipt of hazardous materials covered by the manifest excePl as noted in Item 18a Month 5, ".n <br /> C Pontedlryped Name--y' Signature <br /> E <br /> U EPA Form 8700-22(Rev 3-05)Previous editions are obsol0t< DESIGNATED FACILITY TO GENERATOR <br /> a O N <br /> U U = - <br /> .� 05 State Law Requires that you keep this Receipt/Bill of Lading on file no less than 9-yeers. 0 <br /> U 2 <br /> Z) T _ W <br /> Uo0 0 <br /> � CY) NO U <br /> N = <br /> � r I <br />