COMPLIANCE INFO_2019 - Laserfiche WebLink

Home Browse Search

1111111111111111101 Please print or type. Form Approved.OMB No.2050-CO39 UNIFORM HAZARDOUS I.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.rdan!fast T,7ck:n{g Number Q'7 WASTE MANIFEST *'011_ :-- ' t?'t57r;'t;t ? 01312079 ( FLE 5.Generator's Name and Mailing Address Generators Site Address(if different than amill il address) T)+� ia.r^ ,?neral. -II3568 Dollar General.#.13568 :v1`:38; i.64 560 NOR1•I-i M11 i 1 STRFUT .5,071 Nf IRTI-1 MA T N '�T 2F(:T Generators Phone: mprl'T IFCAI CA i 95336--3917•0 I MANTECA CA 95336-3901 6.Transporter 1 Company Name U.S.EPA ID Number <3a1t;+ W ;`n l:Tolut, l.arla :nc: Ih1RI SZ14"0I.1111924 7.Transporter 2 Company Name U.S.EPA ID Number Recovery Sa stcnla ICAa000175422 8.Designated Facility Name and Site AddressY m t fn e4 Yes, i_L.(: U.S.EPA ID Number 2730 E. 13th Street Facility'sPhond 2-:D F,4Z>893(A I n 7 1,M rA AF.1 Cq:=-I, 9a. 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(it any)) No. Type Quantity WuVd. : n:" FCICRc •l 110zar lomat wat:toy :.Ol id (Cona�'.I6er C` 000 1.6 P 331 W w R(:Ft� ', .;�;.r�drrt-l5 waste, J rti.d (CD!1sumer � )F �1��4�' P 33I (D Product,: 3. 4, 14.Special Handling Instructions and Additional Information I t 10529(Non-RCRA SO I i d Wait a (CA On l y) - 1-do s e p ac k) 2. (i\I'.!r-Rl-,RA I_lq ,.id W:nst:.. CA Orl).>.} L.cos-rl..c•r} 15. GENEW1 GR'"aiGFFEROWS CERTIFICATION:I hereby declare that the contents of this consignment are fully and accurately described above by the proper shfppmg name,aryl are classified,packaged, marked and labetediplacarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations.if export shipment and 1 am the primary Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowieQrnent of Consent I cattily that the waste minimization statement identified in 40 CFR 262.27(x)(if I am a large quantity generator)or(b)(If I am a small gyantity generator)is true. rs Pdo yped 5i`gnalu / Month Day Year �G kyn 2 11l /f ��117I� I:�� :#iA t q 16 lematonal Shlptrtdxrts 1:1Import to U.S. ❑Export fr U.S. Pa entrylexit f Z TrarrspofW signature(dor exports only): ,� a Ieavirr!'i U.S.: W 17.Transporter Acknowledgment of Receipt of Materials n a Transporter 1 PrintWyped Name + Month Day Year R 'rtthanv Mack Z Transyller 2 Prinledqyped Name Sig lilwa coy Year 18.Discrepancy 18a.Discrepancy Indication Space ❑ ouantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number J_ V Faalily's Phone: W 18C.Signature of Alternate Facility(or Generator) Month Day Year a Z y19.Hazardous Waste Report Management Method Codes(i.e.,codes sf}for 'hazardous waste treatment disposal,and recycling systems) LU 1 �ui i IZ -1 1 l Ll i I3. I4. 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 Q�11nu.0 t 2 I I �I 10 EPA Form 8700-22(Rev.12-17Y Previous editions are obsolete. W 06ED FACILITY TO EPA's e•MANIFEST SYSTEM