COMPLIANCE INFO_2015 - Laserfiche WebLink

Home Browse Search

D T ': (_ . 1V0 h.h.li ..1 3 + t Please print or tvne- (Fnrm desioned for use nn Plitp 119-nitrhl tvnpwntpr 1 EPA Form 8700.22 (Rev. 3-(5) Previous editions are obsolete. - iDESIGNATED FACIUTY TO GENERATOR STATE (IF REQUIRED) C:ean Hart rs has the aapropnate Dern its for and AM � , .. �- -�- the per,?ratcr I. smori t8 10413.0077 UNIFORM HAZARDOUS 1. Generator ID Number 2. Page 1 of 3. Emergency Response Ptione 4. Manifest Tracking Number WASTE MANIFEST C A L 0 0 0 2 8 0 3 9 9 483-3 18 0010915-50 F L E 5. Generator's Name and Mailing Address Generators Site Address (if different than mailing address) Tamet Stole T-1526 2193 Spreakt_ls Ave Manteca , CA 95338 Generators Phone: , r_ r 2_ =4 ra atiru Pr'nr•r,,menr ame 6. Transporter i Company NU.S. EPA ID Number Clean Harbors Ene�Fcnflnennl Ssroices Inc M) A 0 0 3 9 3 2^2 5 7. Transporter 2 Company Name U.S EPA ID Number t C -1W AAC S ✓ S ✓C 5 .31 L �_ ? 90 8. Designated Facility Name and Site Address U.S. EPA 10 Number Clean H>Jbors La Porte LP 800 B�EalegroundRoad T X f7 9 8 2 2 9 0 1 4 0 FJ,Ai P,rPrRlne:Tx 77 11 in nnn . ga 9b. U.S. DOT Descnpl on (including Proper Shipping Name, Hazard Class, 10 Number, 10. Containe s 11. Total 12. Unit 13. Waste Codes No. Type HM and Packing Group (if any)) Ouantiry, WUVoI. ocUN 1. 1978,E ASTE PROPANE,2.1I PONE CZ009 343 009 C aa0005 P (K OUT 80911 Z 2. W 3. I 4. 14. Special Handling Instructions and Additional Information 1. LCY1 LP 11tCYLE 8N1xD5Da r r I VVL- 1894Ti6 FLEE 55234 LMARGET-D21 15. GEN ERATOR'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, 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 Exporter, I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a) (if I am a large quantity generator) or (b) (if I am a small quantity generator) is true. torsi erors Printe yped Name igna ren on ay ear a12 r %� i1 .Wl/ 05 10B J H 16. International Shfpments Import to U.S. ❑ Export from U.S.. Port of entry/exit Transporter signature for exports only): Date leaving U.S.: W 17. Transporter Acknowledgment of Receipt of Materials K Transporter 1 PrintedfTyped Name Signature Month Day Year N Peter Huang G 05 1 2 O E Z Trans o tedlTyped Na/me JA Month Day c, Year 18. Discrepancy 1Be. Discrepancy Indication Space ouanti Type ty ❑ yp El Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number. 18b. Alternate Facility (or Generator) U.S. EPA ID Number _J V Q LL Facility's Phone: LU 18c. Signature of Altemate Facility (or Generator) Month Day Year Q Z 0 rn 19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) G 1. 2. 3. 4. 20. Designated Facility Owner or Operator. Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Pnnted/Typed Name Signature Month Day Year EPA Form 8700.22 (Rev. 3-(5) Previous editions are obsolete. - iDESIGNATED FACIUTY TO GENERATOR STATE (IF REQUIRED) C:ean Hart rs has the aapropnate Dern its for and AM � , .. �- -�- the per,?ratcr I. smori t8 10413.0077