COMPLIANCE INFO_PRE 2019 - Laserfiche WebLink

Home Browse Search

Pleas.:yint or Iy (Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 UNIFORM PZARDOUS 1.Generator ID Number 2.Page 1 of 1 3,Emergency Response Phone 4.Man'dost Traclring Number WASTE MANIFEST A L 0 0 0 2 9 6 7 5 0 1 1-0100-42 931J'J' 013482960 J K 5.Generator's Name and Mailing Address Generators Site Address(If different than mailing address) Cooks Collision or Tracy Cooks Collision of Tracy 1'104 Morin St 2930 Aum Plaza Dr.*.`110 rYOCrd l.y [ C n n�•�n,e Generators Phone: 9 ; f3 788 - 29401 6,Transporter 1 Company Name U.S.EPA ID Number En-- ironrnerrtsl Lo isi'tcs, Inc. C A R 0 0 0 2 '1 7 5 1 3 7.Transporter 2 Company Name U.S.FPA ID Number 8.Designated Facility Name and Site Address U.S.EPA ID Number i Filter Recycling Services,Inc. t 1SO10J.€alonte-.yen!e Sloorringwin C;, 92310 Facilitlrs Phone:900 421-20-12 C A 0 'J 8 i 4 4 9a, I 9b.U.S.DOT Descdpdon(ncluding Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit HM and Packing Group(if any)) 13.Waste Codes No. Type Quahtily Wt.(Vol, 1Non-r CRA Ha_ardrr;s Vtste Said(Empty Paint Cans) ,_� O „-- o— C'M Loi I z 2. co 3. 4. i 14.Special Handling Instructions and Additional Information �)fS}En�ty Paint�tiN 1 cJ2il,- 1 u X2130- ) � 15. GEi`IERATOR'SIOFFEROR'3 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 cenform to the terms of the attached EPAAcknowledgment of Consent. I certify that the waste minimization statement Identified in 40 CFR 262.27(a)(if I am a large quantity generator)or P)(f I am a small quantity generator)is true. Generator's/Offerors Printecirryped Name 9 Signature Month Day YeaA 16.International Shipments I F— ❑Impart to U.S. ❑Export from U.S. Port of entry/exit: '= Transporter signature(for exports only): Date leaving U.S.: crit 17,TransporterAdmoWedgmentofRece tofMaterials Tr' porter 1 P ted/Typed Name Signature Month Day Year a � a � I Vi QTransporter dnl d(rypedName Signature Month Day Year 18,Discrepancy 18a.Discrepancy IndicatJon Space ❑ Quantity ❑Type yp ❑Residue ❑Partial Rejection El Full Rejection I Manifest Reference Plumber: 18b,Alternate Facility(or Generator) U.S.EPA ID Number 1 J U i! Facility's Phone: 18c.Signature ofAlternate Facility(or Generator) Month Day Year � � r 19.Hazardous Waste Report Management Method Codes(Le.,codes for hazardous waste treatment,disposal,and recycling systems) 0 1. 2. 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Printedi7yped Name Signature Month Day Year EPA Form 67DO-22(Rev.3-05) Previous editions are obsolete.