COMPLIANCE INFO_2019 - Laserfiche WebLink

Home Browse Search

Please print nr tvne (Fnrm desinned for use on elite (12-nitch) tvnewriter.l Form Approved. OMB No. 2050-0x39 EPA Form 8700-22 (Rev. 345) Frevious editions are obsolete. / - `�ESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED) !3700-2212v'.3 CALE0072032 541053281 17413333554 M PD022619 SDO22619 UNIFORM HAZARDOUS1. Generator ID Number I 2. Page 1 of I 3. Emergency Response Phone 4. Manifest Tracking Number IS775772669 011386185 F L E WASTE MANIFEST ,.r�'.`r',1' 4' 037 4240 I 5. Generator's Name and Mailing Address Generator's Site Address (if different than mailing address) Le 1131-. GEnE1, a1 #] 3�JF 5 E'i, , i 3i" UC 1Si.i h t _CE" 2096849866 -2150 W ALPINE AUE 2150 w A' i'tNE A jE Generator's Phone:T!3Ck.Tt7N, CA 352114 STOCK170N. A�iC+D32-$5 ; 6 Transporter 1 Company Name U S. EPA ID Number '^ i' I CvC:12 suecla!t�,, (ti;;cte Satfit 1CPi'. 1ri;' I I�tI�^�00It. 1Jkf��'i 7 Transporter 2 Company Name U.S. EPA ID Number r I Yy d e.-r-eo B. Designated Facility Name and 31te Address } I s t C-' e l lr ,7 EMN. LL`:. US EPA ID Number G Fernley. NV B9408 Facilit 's Phone: 7 7 557 527 60 Ni t I a E-95 21r ga, 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Containers 11. Total 12. Unit 13. Waste Codes No. Type HM and Packing Group (if any)) Quantity Wt.Nol -X 1UN1791. Waste Hvoochlorite Solutions 8. PG I CE 0$005 P t22 D0022 cc 0 II1, ERG#15A w X 2UN1950. Waste Aerosols. flamnabie 8.1. ERG#126 I CF 00015 P 3:1 D001 cU 3. 4. 14. Special Handling Instructions and Additional Information 1, l I 121517 €. E11 to ach , L, l o u l d l 2.110541Aerosols) 15. GENEMIOW&OFFEROR`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, marked and labeled/placarded, 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 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 a large quantity generator) or (b) guard ty generator rs GTrV mrLs Pn Namemomn ay it \- I I i�i� I 2EiOI9 F 1b.International Shipments 1 ❑ Import to U.S. ❑ Export ftr U.S. ,Dortof entry/ it: Transporter sgnature (for exports only): n leavi U.S.:/ w 17, Transporter Acknowledgment of Receipt of Materials ransporter 1 Pnntedrryped Name Month Day Year a Anthony Mack 02 26 019 QTranspo r 2 Pntedy/Ty�pe�d,Name Signature Month I Year It'll may � B. Discrepancy 18a. Discrepancy Indication Space ❑ Quantity El Type El Residue ❑ Padial Rejection Full Rejection Manifest Reference Number: 181b. Alternate Facility (or Generator) U.S. EPA ID Number J U LL Fadlitv's Phone: w 18c. Signature ofAltemate Facility (or Generator) Month Day Year z 19 Hazardous Waste Report Management Method Codes (i.e„ codes for hazardous waste treatment, disposal, and recycling systems) -PT u C3 77 --2-1 I2 � ! � 1 13.I4. 20. Designated Facility Owner or Operator: Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a rInte'aT a gnature Month I Day Yfl I EPA Form 8700-22 (Rev. 345) Frevious editions are obsolete. / - `�ESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED) !3700-2212v'.3 CALE0072032 541053281 17413333554 M PD022619 SDO22619