Laserfiche WebLink
^� <br />FEB <br />27 2017 <br />#122. Found Signed copy of Manifest #003146421GBF and is now within all of our Paperwork. <br />I <br />OT <br />n <br />nnn.nvn i r1MR No. 2050-0039 <br />ease <br />EPA Form 87011.22 (Rev. 3-0 <br />print or type. (Form designed for use on elite (12 -pitch) typewriter.) 4. Manliest Tracking Number <br />Number 2. Page 1 of 3. Emergency Response Phone /fl� ��± (� QQ <br />1. Generelor ID <br />i,�74rC`^lJ <br />HAZARDOUS AL(1UU•1U:XitSi 1Q43'2tb COUO <br />MANIFEST rs SBeAddress (d di8erenl than manTurg address) <br />rs Name andMailing Address <br />FUNIFORM <br />t)iNRCHA T IRE REPAIR <br />1601 W.0IARTER WAY <br />g1UCKIfi,,N,GA 95200s <br />1U�1-? I b-d�UG U.S. EPA ID Number <br />Phone: <br />r 1 Company Name CAL000� 1971 S <br />AMERIC7uJ VALLEY VVASIE OIL, li:v:. <br />er 2 Company Name CARQOUi"15123V401tLUVVIUE <br />RtCC�VLl4Y S r:; I LNV6 IMuU.S. <br />FDesignated <br />EPA ID Number <br />Faality Name and Site Address YUMA'fES LLC A4110fN1175A j' <br />2730 E. 131 H ST <br />YUMA, AZ a53135 <br />Fac gitysPhone: 020'042-8848 <br />10. Containers 11. Total 12. Unit 13. Waste Codes <br />9b. U.S. DOT Description (indudirg Proper Shfpp'ng Name, Hazard Class, ID Number, <br />Quantity WUAI. <br />ga e <br />HM and Packing Group Cd any)) No' Ty, <br />r <br />1. nK1N-R0RA HA7ARD0JS WASTF SOLID I 1-)hL 251 1) <br />A8S0RBF1%IT,PAPER All FII TERS 6 DEBRIS <br />Z <br />2. <br />w <br />c� <br />3. <br />4. <br />14. Special Handling Instructions and Additional Information <br />PROFILF011937zq n7� ERAii iY4 EtviERGENCYCONTACT- GASVIR <br />1) 1 �es5" <br />16. GENERATOR'SIOFFEROR'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, <br />marked and laiNledlplacarded, and are In all respects in proper condition for transport according to appliicab'e international and national govemmental regulations. If export shipment and I am the Primary <br />Exporter, I certify that the contents of this consignment conform to the terms of the attached EPAAcknoWedgmenl of Consent. <br />I certify that the wasle minimization statement Identified In 40 CFR 26227(a) (If I am a large quantity generator) or (b) (AI am a small quantity generator) is We. <br />Generatoes/Offerors Printedrryped Name Signature Month Day Year <br />�j <br />F <br />16. International Shipments <br />Importb U.S. ❑ Export From U.S. Pod of enhyledl: <br />Transporter signature (for exports only): Date Laying U.S.: <br />17. Transporter Aclumledgment of Receipt of Materials -� <br />Transporter i nt d/r Name re Month D y Y <br />IL <br />tit <br />aTram2 <br />`p. y <br />Pdnled7ryped am �.�' <br />KI = <br />H <br />KI A <br />18. Discrepancy <br />1 Ba. Discrepancy Indication Space ❑ Quantity ❑ Type ❑ Residue - ❑ Partial Rejection ❑ Full Rejection <br />Manifest Reference Number: <br />185. Alternate Facility (or Generator) U.S. EPA ID Number <br />U <br />ra+. <br />Facility's Phone: <br />w <br />18c. Signature ofAlternate Facility (or Generator) Month Day Year <br />Z <br />N19, <br />Hazardous Waste Report Management Method Codes (is., codes for hazardous waste beatmenl, disposal, and rxcyd:ng systems) <br />LLI <br />1 2. <br />20. Designated Facility Omer or Operator. Certification of receipt of hazardous materials covered by the manifestexcept as noted In Item 1Ba <br />PdntedrTyped Name n Signature th Day Year <br />aN 05 <br />5) Previous editions are obsolete. <br />DESIGNATED FACILITY TO GENERATOR <br />