Laserfiche WebLink
Rieasepinler type, r, ;Forrn,Appmed.3UB No.20%4039 <br /> MWORV HAZARDOUS 2 Pq itiffest Tracking Number <br /> JJK <br /> WASTE VANIFEST 6 3 6 11 <br /> '5!Gererator'sham.andiMalliRgAgress / �dtlressi <br /> V&iQ f-WjWE8'0'M1 <br /> 212 44 (61k!*L 06, <br /> s7orl*(70" Ck 25206 <br /> Generator's iRhorRe. <br /> Transporter I(CempanyUmm US.E%l[DViff0lsar <br /> WORLD Ut E%IRCIO&EXTAL W—VOCES CA00292770!��-: <br /> or,impmmer2'Company Name 12S.SPAViVindber <br /> Des4naled;FacilityiNameaf.YdSL-Address twS.B%213lumber <br /> LIS'EC(Abyjklf VER"evil 90C <br /> 6375 SWIN WYLE AVENUE <br /> LCIS A&GELES CA <br /> Facility's Phone: 11'�111.1%4 7)'�1 Cc G 0 9 7 0)3 1113 9 9 3 <br /> 9a 9b.'U S IDOT Descripliom,(4milltding Pq:ier Sh,ippimg hlrm.'Razard Class JID Number !LC&rta� eT: Tidal 12.11111`nft <br /> H13.'Waste Codes <br /> j,jj amd!P=kh9 Growip(jif aro) % Type <br /> !!.'7�ARDOUS WASTE,SCUD JAC 4YL� <br /> 0 <br /> Z <br /> RECRIVIa- <br /> SEP 0 9 20 0 <br /> 14.Special Handfing Instructions and Additional Into...ation <br /> EMERGEKY GONTAGI :CHEMTREC 1-1300424-9300:WOESi TERMIWAE.:CEREi CS f;KEW3,#961 I'll Pjr,:W6LE- 96, <br /> 6649�SPE"Ir TAC OIL, A PWJ-0W0-q' 82!5' kAFF'W-3PRfXFE PPE FQLhPMF-h1 <br /> / Y 15 <br /> 15 GENERATORSMFFEROR'S CERTMATION: 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 labeled/placarded,and are in all respect in proper condition for transport according to applicable intemationaland national governmental,regulatians.ffexport shipment and I am the Primary <br /> Exporter,I certify that the contents of this consignment cord to the terms of the attached EPA Acknowledgment of Consent . <br /> I certify that the waste minimization statement identified in Q CFR 262.27(a)(if I am a large quantity generator)or I am a imall quantity generator)is true. <br /> Generator.s/OfFeror's Printed/Typed Name Signature Month Day Year <br /> e� <br /> X 11 ; <br /> _j 16.International Shipments <br /> P. ElInvort to U.S. Export from U.S. Port of entrylexit: <br /> M Transporter signature(for exports only): Date leaving U.S.: <br /> W 17.Transporter Acknowledgment of Receipt of Materials <br /> LU <br /> Transporter I Printed/Typed Name Signature UorM Day Year <br /> Go -AA -7 <br /> jz Transporter 2 Nntwffyped Name Signature ,Month Day Year <br /> ;9 <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space y Type El Residue ElParbal Rejection E]Full Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> LL Facility.,Phone: <br /> LO 7&—Signature of Alternate Facility(or Generator) <br /> U Momf Day Year <br /> 19 Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment disposal,and recycling systems) <br /> Uj 1 2, 3. 4 <br /> In I --- 1 <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Printed/Typed Name Signature Month Day Year <br /> EPA Form 8700-22(Rev 12-17) Previous editions are obsolete GENERATOR'S INITIAL COPY <br />