COMPLIANCE INFO - Laserfiche WebLink

Home Browse Search

r � vF;��.:. •..:?m' E n i`r^, + j4yv`i t''. r .,a.,' - �s�.-» nt or type.(Form designed for use OR (l2-pitch)typewriter.) ry Farm Approved.OMB No.2050-0039 NIFORM HAZARDOUS 1 Gerreralar IU 2.Page 1 of 3.Emergency Response Phone 4.Ganifest Trdcl irg Number WASTE MANIFEST C&00 8$ 7 7 0 3$ 1 1 EBt j 42 4.9�G �,4 JJ K 5.Generators Name and MaDin Address Generators Site Address(if different than maNng address) E �>1�3� :t:�k S. t AVE UUMON CA 9 221 feneraters Phone 3�4 (i Tis f" e: U.S.EPA ID Number � Cii1MENTAL CES t:A D 0 2 3 2 7 J)3 6 T.TaaanAa2CoraperryName ; U.S EPA ID Number DesgnatedFacility Name and Site Address r U.S.EPA ID Number -- At " s Phone 9a. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit HM and Packing Group(if any)) 13.Waste Codes No. Type Quantity WtNol" 1 NO KR KAZARtirCk. ''7E,IJQtW ED Ott/ MIXED ML.) O _/ " 's 001 T j z 2. W i 3. i 4- 14. 14.Spedal Handling InMnoons and Add-Mmal Infa,Tnation EMERGENCY M44TACT "CHF..TRI_;; AF1PF1 FfifA7E PE;Z5vfW PV"'ATI i F--;.QF11AE N i ' EVIEK ?�-)NTACT C14F_MTREC WO 42 4 93(A) x iT?WX*.�__——' 15. GENERATOR'SIOFFEROR'S CERTIFICATIO : 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 FPAAduawledgment of Consent I certify that the waste minimization statement' ntified in 40 CFR 26227(a)(if 1 am a large quantity,generator)or(b)(41 am a small quantity generator)is We. Generator'slOfferor's PrintedrTyped Name Signature Month Day Year _l 16.International Shipments r� pa10 S. uEx ❑ImportfranU.S. Port nfentrylexrt: -- -----_— -- — - Transporter signature(for exports only): 'Date leaving U.S.: W 17.Transporter Acknowledgment of Receipt of Materials Transporter 1 PrinfedlTyped Name ` Signature. Month SDay Year IL a< Transporter 2 1`4ntedfryped Name } Signature Month Day Year r 18 Discrepancy 18a.Discrepancy Indication Space ❑ Quan ity ❑Type ❑Residua ❑Pa1ia1 Resection ❑FuD Rejection Manifest Reference Number. 18b.Alternate Faality(or Generator) U.S.EPA ID Number J U U- Facirtys Phone: w 18c.Signature of Alternate FacgTity(or Generator) Month Day Year !;C- 19- 19.Hazardous Waste Report Management Method es(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) LU 1. 2. 3. 4. 20.Designated FaoTity Owner or Operator Certifica ion of receipt of hazardous materials coverej by the manifest except as noted in Item 18a P6nled/rypcd Name Ngnahxe Month Day Year EPA Form 8700-22(Rev.3-M) Previous editions ire obsolete. GENERATOR'S INITIAL COPY