Laserfiche WebLink
Pleas0 print or type.(Form designed for use on elb(12-pitch)ty writer Farm Approved.OMB No.2050 E>099 <br /> UNIFORM HAZARDOUS 1'Gwsrawr ID Number 2.Page 1 a 3.EmerQeray Response Plwna 4.Mantfest Tracking Number <br /> WASTE MANIFEST CAL000268997 1 600-424-9300 014995488 JJ K <br /> 5. Generators Name and Malhng Address Generators Site Address(If crarent than mar 11 address) <br /> LKQ Auto Farts - 2041 Navy Dr <br /> 2041 Havy Dr. <br /> Otockton, CA 95206 <br /> GeneratoPs Phone: A In 51 ii—517 q <br /> fi Transporter 1 Company Name U.S.EPA ID Number <br /> ToxldwLde Recovery S stcas <br /> Transporter 2 Canpsrry Nems U.S.EPA ID Nrm lw <br /> Ceslgnated Facllly Name and SIt Address U.S.EPA ID Number <br /> Veolia ES ?eehriical Solutions LLC _ Azusa <br /> 1704 V. Fi=st Street <br /> Azusa, CA 91702 <br /> Pa a!;Vs Phone: 626-334-5117 <br /> 9a. 9b,U.S.DOT Dworlpfion(Indu&V Proper Shipputg Nam,Hazard Class,ID Number, 10.Corbiners 11.Total 12.Unit 13.Waste Codes <br /> HM and Paddng Group(if arry)) No. Type Quantity WLAId. <br /> 1. , 018 212 <br /> ON IP, ►'VAS 5oLn1ff 3 1 <br /> 2. <br /> 3, <br /> i <br /> i <br /> 4. <br /> 14.69"1 Handling InstrucU ns aid Acidtoral Iniomratlon <br /> 1) E2Vw #- Vii; 788308 <br /> bill to VM; Wear FroFe* PPE Clothing; **Ira case of eaer9ency acmtaet CREMBEC (900) <br /> 424-9300 Registrant #C9C!!1't97473* ■O# 510059 Al, <br /> 5 GENERATOR'S10FFEROR'S GERnFICATION:I hereby dedwe that the cortsnls of ft cm*nmwt are fully and awately described ebeve by the proper ship N name,and are classified,packaged. <br /> marked and labeledfptacardod,and are In a9 respects In proper condition for transport acoordkV to app9ceble kdemationai and nadorwl governmental repaladons.It export aNpmant and I am the Primary <br /> Exporter I c&*that the contaft d this conslgrxrterrl conform to the temrs of the altaded EPAAdtnowladgment of Consent <br /> I certi-y that the waste In40 CFR 26227(8)(7I am a large quan*generabor)or(b}(WI am a email quant mere <br /> Gererato&ffWs Prntenped Name Sgnatu e Month Day eer <br /> V v&- <br /> IrAsm—affional Shkpnnents <br /> 1" ❑Import to U.S. Export from U.S. Pat of wwazit <br /> _Transporter signature(fa exports cny): Dale IeL�;rg U.S.: <br /> 17.TransporterAdmaaiedgmenrt of Rece;pt of Materials <br /> Uj <br /> �2 irana 1PrintedlfypedName signaNre Montt Day Year <br /> fL <br /> 12z Trarigxwtef 2 Pdntedlfyped Name Signatu Month Day Year <br /> 18.Dlsrxepancy <br /> 18a.Discrepancy Indicallorr Spam ❑ Qrendty ❑Type ❑R.W. ❑Partial P4.d. ❑Full Relecdan <br /> Manifest Reference Number. <br /> 16b.Albsmate Facility(or GeneraM 4 S.EPA ID Number <br /> J_ <br /> V <br /> Farkry's Phone: <br /> LO 18C.Signature of Alternate Facility(a Generator) Month ay Year <br /> y19.Hazardous Waste Raport Management Method Codes(i.e.,oodas for h=rdeus waste beatmmt,disposal,and necyalr g systems) <br /> -- LU 1. 2. 3. 4. <br /> 20,Desigrated Facility or Operator:Certifrcatlon of receipt of ha=s ! materlals eovww by the rrurWo t as rated is Item 188 <br /> Printadrryped Name ature on Da Y r <br /> EPA Form 8700-22(R , 5) Previous eftotis are obsolaw. p ACIL TO DESTINATI N TATE(IF REQUIRED) <br />