Laserfiche WebLink
2763 Boeing Way, Stockton Record ID PR0542371 <br /> 3/18/2019 <br /> Photo 1: Manifest number 010512477FLE (2/10/2017IF, was found without a signature from the TSDF. <br /> Form designed for use on elite(12-11 typewriter.) - Form Approved.OMB No.2050-0039 <br /> i.Generator ID Number 2.Pae 1 of 3 Emsr nc Res o se Phone 4.Ma If st Tracking N tuber <br /> RDOUS 9 9e Y D n <br /> MANIFEST r ) $ / <br /> Yi <br /> ,� . 7 FLE � <br /> s Name and Mailing Address <br /> Generators Site Address(if different than melting add s)✓ <br /> f i <br /> emlor's Phone: O� <br /> carspoder 1 company Name U.S.EPA 10 Number / \ <br /> it <br /> 7.Transporter 2 Company Name <br /> U.S.EPA ID Number / <br /> 8.DesignatedFClty Name and Site Address U.S.EPA ID Number <br /> ,y+ F2olty Phone ✓fir / <br /> =� gra gb U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers <br /> > HM and Packing Group(f any)) 11.Totel 72.Unit 13.Waste Codes <br /> No. Type Quantity WLNol. <br /> w2. ed Only <br /> c� when <br /> 3. <br /> .lie COSI <br /> Onnel <br /> F ___ for the <br /> se <br /> ia,spatial Handling Inatraefona antlnadnional mrormafon <br /> teed <br /> 15. 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 Iaimedlplacarded,and are in all respects in proper condifion for transport according to applicable international and national governmental regulations.If export shipment and I am the Primary <br /> Exporter,I certify that the contents of this consignment confoan to the terms of the attached EPA Acknowledgment of Consent. <br /> I certify,that the waste minimization statement identified In 40 CFR 262.27do(if I am a large quantity generator)or(b)(if I am a small quantity generator)is we. ,t we <br /> Generstofs Offerofs Printedryped Name Signature Month Day Yen, <br /> 16.International Shipments <br /> ' f— ❑Import to U.S. ❑Export from U.S. Port of entry/exit: <br /> Trans otter si nature for ex onsonl Date leavin U.S.: <br /> X 17.ThomparterAcknowledgmenl of Receipt of Materials <br /> Transporter I PnntedTTyped Name Signatore om ay ear <br /> z Transporter 2 PrinsollTyped Name Signature onih Day <br /> a Year <br /> ♦ 18.Discrepancy <br /> 18a,Discrepancy Indication Space ❑Quantity ❑ Full Rejection <br /> El Residue Panial'Rejeclion l <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> U <br /> Q <br /> LL Fad 11's Phone: <br /> W ific Signature of Alternate Facility(or Genembr) Month Day Year <br /> ti <br /> LD <br /> Q <br /> 2 <br /> N ig.Hazardous Waste Report Management Method Codes g.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> � i. <br /> 1 26 Designated Facility Owner or Operator:Cedlfication of receipt of hazardous materials covered by the manifest except as noted in Itam 18a <br /> PrinledlTyped Name Signature Month Day Year <br /> EPA Form$700-22(Rev.3-0¢)Previous editions are obsolete. GENERATOR'S INITIAL COPY <br /> John Alaniz, REHS Page 1 of 3 <br />