Laserfiche WebLink
Please point or".(Farm desE ned 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.Emerwey Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST CAL 0 0 0 3 8 5 7 0 3 1 (800)424.9300 0 1 8 2 3 6 6 6 8 JJ K <br /> 6.Generators Name and MnNln Address Generators Site Address(If different than mailing address) <br /> ANTONINI ENTERPRISES LLC-LATHROP <br /> P.O.BOX 8468 <br /> STOCKTON CA 95208 701 IYARCY PKWY <br /> GeneratolsPhene• 209993-8695 LATHROP CA 95330 <br /> 6.Transporter I Com a Name U.S.EPA ID Number <br /> AS9UENVIRONMENTAL SERVICES CAD 0 2 8 2 7 7 0 3 6 <br /> 7.Tiensporler 2 Company Nome U.S.FPAiDNumher <br /> a.DesignatedFadi me and Site Address U.S.EPA ID Number <br /> US ECOLOGY VERNON ING <br /> 5375 SOUTH BOYLE AVENUE <br /> LOS ANGELES CA 90058 <br /> CAD 0 9 7 0 3 0 9 9 3 <br /> Fadlil es Phone. (323)277-1500 <br /> ga. 9b.U.S.DOT Oescdptlon(including Proper Shipping Name,Hazard Class,ID Number, 10,Containers 11.Tubal 12.Unit 13.Waste Codes <br /> HM and Pacfdng Group(Ifany)) No. Type Quantity wuVol. <br /> a I. NON-RCRA HAZARDOUS WASTE,SOLIDS(OILY SOLIDS.PAPER352 <br /> FILTERS) D IV P <br /> us <br /> ous <br /> w <br /> sn <br /> 3. <br /> 4. <br /> 14.Special Handing In51Puct1un5 and Additional Information <br /> EMERGENCY CONTACT:CHEMTREC 1-800-424-9300 NAERG#981:171*PROFILE#9B1:P205707 OILY SOLIDS,PAPER 113% <br /> FILTERS*P500-00047492*APPROPRIATE PERSONAL PROTECTIVE EQUIPMENT <br /> 2,a-4,�----- <br /> 15. GENERATOR'SfOFFEROR'S CERTIFICATION:I hereby declare that Ow contents of this consignment are fully and accurately described a5ove by Die proper ships name,and are classified,packaged, <br /> marked and lebeledoacarded,and are in all respects In proper condition for transport according to Applicable inlemablal and national governmental regulations.If export shipment and I am the Primary ' <br /> F•xparter,I certily that the contents of this consignment conform to Bre terms of the abched EPAAcknoM9grr Ant of Consent. <br /> I eertlfythat dlewaste hmirellan statement identified in 40 CFR 262.27(a)(111 am a large quentily iia n or(b If I am a small quantity generator)is true. <br /> Ganeralprsl0ffemrs Prin )pact eme nature Day r <br /> '0- / s <br /> -+ 16.hnlemational5hlpments <br /> exit <br /> Tmnapartersignebrre(for exports only): Import to U.S. El ExpoA from U Date leavi gPort of rU.&: <br /> 17.TrarnsporterAekrowledgment of Receipt of Materials t <br /> 0Tramporter <br /> drryped 5ignalure P o Day r <br /> I D <br /> Q Transporter 2 PdntedrTyped Name SlgnaArre Mantlt {1a r <br /> 18.Discrepancy <br /> Iiia.Discrepancy Indication Space Cl Quantity ❑Type ❑Residue ❑Partial Reed ion ❑Full R*dlon <br /> Manliest Reference Numbor: <br /> 1Bb.Alternate FacHity(or Generator) U.S.EPA ID Number <br /> V <br /> Facnitys Phone: <br /> W 18c.Signature ofAllemate Facility(or Generator) Month• Day Year <br /> a • <br /> Z <br /> rc19.Hazardous Waste Repel Management Method Codes pia.,codes for hazardous wrests beatmenl,disposal,and mcyding systems) <br /> LU 01 � l_ f z. a a. <br /> Ll20.Daslgnoted Faci y Owner or Operator.CertifipUon of recalph of hazardous materiels covered by W manifest except as noted in Item 18a <br /> 8-1 L 6L 1 74D kup 0 LN- I <br /> PrintedffypedName. Signaerre Month Day r <br /> EPA Form 8700-22(Rev.3.05) Previous editions are obsolete. DESIGNATED FACILITY iUESTINATION STATE(IF REQUIRED) <br /> 12786.0891 <br />