Laserfiche WebLink
�° <br /> 1.Generator ID Numb6r` 3g <br /> UNIFOt M HAZARDOUS �, Page 1 of 3. Resflonsephoite !1.. o ng umber ' <br /> 1NiASJ MANIE'SST , h At YC €3 49 'y&�45 <br /> Generators Name'{{tflNaliing Address' ;. r3enerator s Site Address(If different than mailing address) <br /> E3 � A t AR LSE A ' OL,t N SA <br /> TRACY, CA 96377-- <br /> Generators Phone: —8393934 <br /> 6.Transporter 1 Companme4 <br /> PACIFIC RNaOURCE RECOVERY SERVICES. . 5240 <br /> 7.Transporter 2 Company NaMe U.S EPA ID Number i <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number <br /> PACIFIC RESOURCE RECOVERY SERVICES GAL70085740 <br /> .33.50 EAST RICO BLVD. <br /> LOS ANGELES, 0023 0023 <br /> FacilitysPhone: {�� 499-7145 <br /> 9a. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,lD Number, 10.Containers 11.Total 12,Unit <br /> HM. and Packing Group(f any)) 13.Waste Codes <br /> No. Type Quantity Wtivol. <br /> �L-Jluultv--1 01 <br /> .411 IMN <br /> ?CLLmAL�tINO C3L,U'TION7 (CAI. c IA R L1LvATEL� <br /> 4. <br /> 14.Special Handling Instructions and Additional InhfoayrNm�atign Yj�fi <br /> ...:: ..r . vr;,w h T�, K`�•�5.�t,q�v'7 .. i}L.. .ak .:.. - +-..t-',�r*i'a:.. -.�+�'. ',a:T4 a41c;s'i_ per. —T 4-Y a<.i--L.- r.:.:.lut ..r-�.:,..r - a:r..a:. •t' <br /> OL:t1VES, GOGGLES & PROTE'CTIV ; CL THING Z4HR EMERGENCY NT' T. KIR L QO F <br /> ERAN tipN NONE 4 �I 111�I�I �I 1 <br /> TRANSPORTER .�. ,PHCN '� 1�OB8�2 �'71t4E� <br /> 16, GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby 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 respects in proper coriditiorl for transport according to appllgable International and national govemmental regulations.If export shipment and t am thePtimary <br /> Exporter,l certify that the contents of this conslgnment 66610*::fo th'eterms of lite attached EPAAcknowledgment of Consent. <br /> I'certify that the waste minimization statement Identinedtri.40 GFR262.27(a),(if i am a large quantity generator)or(b)(If i am a small quantity,generator)is true. <br /> e ratoY ogsrers P�nt9dlTYPed Nagle u::. 819I' moil.th 08 <br /> —r 6 Intemational Shipments , <br /> IL. Qlm rttoUS <br /> .F.xpoTt from U 5 P00f entry/ewt:. <br /> . T hsP9ttef signatuFe;{f6r exporte only). Dat`leaving U,S:: <br /> w 17.TransporterAckoo4adgment of ecaipt of Materials .41 <br /> E2 Tran r PnntealIyped / , i ture Month Year <br /> a /5ll) �/ <br /> ZTransporter 2 PrintedlTyped Name tore Month Day Year <br /> I�- <br /> 18.Discrepancy <br /> 18a,Discrepancy indication Space quantity ❑T e ❑Partial Raja yp El Residue, ❑Full Rejection <br /> Manifest Reference Number <br /> 18b,Alternate,Facility(aifGendretor) > ,, a a:, !U:S,EP"ID Ngmbar t <br /> Facility's Phone: <br /> W 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> Q ' <br /> Z <br /> 19.Hazardous Waste Report Management Method Codes(l.e„codes for hazardous waste treatment;disposal,and recycling systems) <br /> LU 1• 2. 3. 4. <br /> 20.Designated Fac(Ilty Owner or Operator:Certification of receipt oihai4r&a materials covered by the manifest expept as noted indtetn•1@a <br /> n <br /> Printgd(yped Name Y Signatu <br /> Day Year <br /> �PAFbrm 8700: 2{ 3:05}Prbypu a3difi-M a' bsbleL rt f <br /> IZtATED FAYriiL Cflt O GEt�EFLATO <br /> f <br />