Laserfiche WebLink
Please print or type. <br />Form Approved. OMB No. 2050-0039 <br />EPA Form 8700-22 (Rev. 12-17) Previous editions are obsolete. DESIGNATED FACILITY TO EPA's e -MANIFEST SYSTEM <br />UNIFORM HAZARDOUS <br />1. Generator ID Number <br />2. Page 1 of <br />3. Emergency Response Phone <br />4. Manifest Trackin Number <br />1016133604 F L E <br />WASTE MANIFEST <br />CAC 0 0 31 2 8 9 0 8 <br />1 <br />(408)363-3078 <br />5. Generators Name and Malling Address Generator's Site Address (if different than mailing address) <br />METAL FINISHING SOLUTIONS OX) METALFINISHING SOLUTIONS (1X) <br />870 COMSTOCK ST 91999 S AUSTIN RD <br />SANTACLARA CA 99054 MANTECA CA 96336 <br />Generators Phone: 2M 7912= <br />6. Transporter 1 Company Name U.$. EPA ID Number <br />ALL CLEAN HAZARDOUS WASTE REMOVAL, INC. CAD 9 8 2 4 9 2 3 9 9 <br />7. Transporter 2 Company Name U.S- EPA ID Number <br />8. Designated Facility Name and Site Address U.S. EPA ID Number <br />US ECOLOGY NEVADA <br />HWY. 9511 MILES SOUTH OF BEATTY <br />BEATTY NV 89003 <br />N V T 3 3 0 01 0 0 0 0 <br />Facility's Phone: <br />9a, <br />9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, <br />10. Containers <br />11. Total <br />12. Unit <br />13. Waste Codes <br />No. <br />Type <br />HM <br />and Packing Group (if any)) <br />Quantity <br />Wt.Nol, <br />x <br />1- UN3262, CORROSIVE SOLID, BASIC, INORGANIC, N.O.S., 8, PC -III <br />DF <br />P <br />181 <br />o <br />(SODIUM HYDROXIDE) <br />I <br />I <br />Z <br />2. <br />LU <br />I <br />3. <br />i <br />4. <br />i <br />III <br />14. Special Handling Instructions and Additional Information - ACH WOil931051 /18991 - CB "" Ell ALL CLEAN PM8991- <br />9bi)070127495-10939 - CONTAMINATED DEBRIS E X gS) N 1 06,04 wt <br />15. GENERATOR'S/OFFEROR'S CERTIFICATION: I hereby declare thatthe 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 condition for transport according to applicable internationaland 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) or (b) (ifl am a small quantity generator) is true. <br />GaneralorsffNteroes PdntedlTyped Name Signature Month Day Year <br />C�Q,4Ve L^ 0 � <br />j <br />H <br />16. International Shipment <br />❑ Import to U.S. ❑ Export from U.S. Port of entry/exit: <br />? <br />Transporter signature (for exports only): Date leaving U.S.: <br />W <br />LU <br />17. Transporter Acknowledgment of Receipt of Materials a <br />a <br />Transporter 1 Printedffyped Name Signature Month Day Year <br />Al I' G / veil 140 1 z r <br />Z <br />Transportef 2 Printed/Typed Name Signature Month Day Year <br />H <br />18. Discrepancy <br />18a. Discrepancy Indication Space Quantity ❑ Type ❑ Residue ❑ Partial Rejection ❑ Full Rejection <br />Manifest Reference Number: <br />18b. Alternate Facility (or Generator) U.S. EPA ID Number <br />J <br />U <br />LL <br />Facility's Phone: <br />W <br />18c. Signature of Alternate Facility (or Generator) <br />Month Day Year <br />Q <br />Z <br />T) <br />19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) <br />LU <br />1 ita <br />I 2 <br />3- <br />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 />Printiffyped Name <br />Signature Month Day Year <br />EPA Form 8700-22 (Rev. 12-17) Previous editions are obsolete. DESIGNATED FACILITY TO EPA's e -MANIFEST SYSTEM <br />