Laserfiche WebLink
PIPaCP nrint nr hmo X—n, d—i—,i f — — .,a,,, mi .._:,... - 61190.17Ri 976 .11Ai `>;f'- PPYt 7/7Fl /9Aa K <br />EPA Form 8700-22A (Rev. 3-05) Previous editit>ns are obsolete. DESIGNATED FACILITY TO DESTINATION STATE (IF RE(IUIRED) <br />Clem Harbors hasthe appropriate permits for and will accept thewaste the generator is shippini <br />UNIFORM HAZARDOUS WASTE MANIFEST <br />(Continuation Sheetj 1CAL000344394 <br />21. Generator ID Number <br />22. Page <br />2 of2 <br />t-orm Approved. OMB No. 2050-0039 <br />23 Manifest Tracking Number <br />00188567 i0FLE <br />24. Generator's Name — <br />Ferouson <br />25. Transporter Company Name U.S. EPA ID Number <br />26. Transporter Company Name U.S. EPA ID Number <br />27a. <br />HM <br />27b. U.S. DOT Description (iricluding Proper Shipping Name, Hazard Class, ID Number, <br />and Packing Group (if any)) <br />28. Containers <br />29 Total <br />Quantity <br />30. Unit <br />WWo. <br />31. Waste Code: <br />No. <br />Type <br />5. NON-RCRA HAZARDOUS WASTE. LIOUIDS. (LUBRICANT. <br />PROPYLENE GLYCOLI <br />004 <br />D NI <br />00620 <br />P <br />551 <br />6. NON-RCRA HAZARDOUS WASTE. LIOUIDS. (ANTIFREEZE. <br />SILICONE) <br />003 <br />D NI <br />00724 <br />P <br />551 <br />7. NON-RCRA HAZARDOUS WASTE. LIQUIDS. (SEALANTS, <br />LUBRICANT) <br />0 0 i <br />D NI <br />00240 <br />P <br />551 <br />0 <br />S. WASTE NON-RCRA HAZARDOUS WASTE, LIQUIDS, (FLUX, <br />SEALANT51 <br />002 <br />D M <br />00495 <br />P <br />551 <br />Z � <br />9. Nom{-RCRA HAZARIXGS WASTE. LIQUIDS, (LUBRICANT, <br />SEALANTS) <br />0 0 i <br />D M <br />00400 <br />P <br />551 <br />10. NON-RCRA HAZARDOUS WASTE, LIQUIDS, (LUBRICANT) <br />00i <br />D F <br />00675 <br />p <br />551 <br />32. Special Handling Instructions and Additional Information <br />5 . LCCRN 4X55 9 _ L('CRN 1X55 <br />6_LCCRN 3X55 10.I,CCRN 1X30 <br />7 . LCCRN IX55 <br />8.LCCRN 2X55 <br />W <br />33. Transporter Adahowedgment of Receipt of Materials <br />F <br />a- <br />O <br />a- <br />PrintedlTyped Name Signature Month Day Year <br />I �_ <br />34. <br />34. Trans rter Acknowledgment of Receipt of Materials <br />Printed/Typed Name Signature Year <br />H <br />U <br />Q <br />ti <br />35. Discrepancy <br />rL <br />Q36. <br />Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal and recycling systems) <br />5. H040 6. H040 I 7. H040 _ B. H04E0 I 9. H04Q <br />h <br />LU <br />n <br />10.1-1040 I _ <br />EPA Form 8700-22A (Rev. 3-05) Previous editit>ns are obsolete. DESIGNATED FACILITY TO DESTINATION STATE (IF RE(IUIRED) <br />Clem Harbors hasthe appropriate permits for and will accept thewaste the generator is shippini <br />