Laserfiche WebLink
G'TSNC 01.11.R.. 0-;73-2- <br /> Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST X22 1 300-424-93-00 004907784 JJ K <br /> 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) <br /> U HAUL 91 12021 <br /> 7701 TAM O'SHAN MR LN. <br /> STOCKTON,CA 95210 <br /> Generators Phone: 209.952-7812 <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> EVERGREEN ENVIRONMENTAL SERVICES CAD982413Z2 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.OeSipnatedFar I;N Na pgyrtd Site Address U.S.EPA ID Number <br /> 6880 SMrrH AVE. rVC CAD==741i Qj <br /> NEWARK,CA 94560 ^n <br /> Facility's Phone: 510.7954400 (1� <br /> 9a. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes <br /> HM and Pac jng Group(if any)) <br /> No. Type Quantity WtN01. <br /> 7`1"47�719 j:�W4<rj <br /> 1. <br /> W <br /> Z 2. <br /> W <br /> 3. <br /> 4- <br /> 14.Special Handling Instructions and Additional Information <br /> proAle erg]7 drum size:S <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accuratey,described above by the proper shipping name,and are classified,packaged, <br /> marked and labeledlplacarded,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 <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. <br /> I certify that the waste minimization statement identified In 40 CFR 262.27(a)(if I am a large quantity generator) (b)(91 am a small quantity gen tor)is true. <br /> Ge toes/Offeroes Pnnted/Typed Name Sign Month 0ay Y <br /> f or �raZ►c.✓ 9 by <br /> J 16,International Shipments <br /> ❑Import to U.S. ❑Export hom U.S. Portof entry/exit <br /> Transporter signature(for exports only): Date leaving U.S.: <br /> W 17 Transporter Acknowledg of Receipt of Materials <br /> Transporter 1 Printed/T fame Signature 001, Montt Day Ye <br /> O <br /> CL <br /> Z Transporter 2 dnied/Typed Name Sig ure Month Day Year <br /> W <br /> H <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space <br /> El Quant ty Type E]Residue ❑Partial Rejection ❑Full Resection <br /> L, t G-C-1-4 --14,7 LG LrQc.t037�Zm/ <br /> 3,!/i✓l49"ZL <br /> C 0941(EFuyD lslb"-VAnifestReference Number <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> Facilitys Phone: <br /> W 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> ZZ <br /> N19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> LLJ o t ► i I�I 2. 3. 4. <br /> 20.Designated Facility Owner or Operator.Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Pnnted/TypedNa� Signature- I :�� Month Day Year <br /> r"� <br /> 1 1 <br /> EPA Form 8700-22(Rev.3-05) Previou ditions are obsolete. ATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br /> 10618.1843 <br />