Laserfiche WebLink
or <br /> /g/13377 /9117 /ge <br />l/ Form Approved OMB No. 2050-0039 4 GENERATOR -- - <br />UNIFORM HAZARDOUS <br />WASTE MANIFEST <br />1. Generator ID Number <br />C A D 9 8 1 6 8 8 3 4 4 <br />2. Page 1 of <br />1 <br />3. Emergency Response Phone <br />844-334-2468 <br />4. Manifest Tracking Number <br />021642719 JJK <br />5. Generator's Name and Mailing Address Generator's Site Address (if different than mailing address) <br />PGE MANIFESTS PG&E MCDONALD ISLAND COMPRESSOR STATION <br />P.O. BOX 7640 2121 ZUCKERMAN RD <br />SAN FRANCISCO CA 94120 1 STOCKTON CA 95206 <br />Generator's Phone: 8 Q 0 7 6 i - 6 0 0 0 I <br />6 Transporter 1 Company Name U.S. EPA ID Number <br />PSC INDUSTRIAL OUTSOURCING, LP I CARD 0 02 6 9 54 8 <br />7 Transporter 2 Company Name U.S. EPA ID Number <br />I <br />B. Designated Facility Name and Site Address U.S. EPA ID Number <br />US ECOLOGY NEVADA <br />HWY 95 11MI S OF BEATTY <br />BEATTY NV 89003 <br />Facifity's Phone: 775 553.2263 I N V T 3 3 0 0 1 0 0 0 0 <br />9a. 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Containers 11. Total 12. Unit 13. Waste Codes <br />HM and Packing Group (if any)) No. Type Quantity WI/Vol. <br />u 1' NON RCRA HAZARDOUS WASTE, SOUD (OILY SOUDS) 352 <br />A <br />0 0 1 CM 22.— Y <br />2 <br />3 <br />4. <br />Special Handling Instructions and Additional Information <br />JOB # 78-1910-0017-J01.47 <br />PROFILE # 070197369-0 <br />l <br />.: <br />hf 1 CO - 44.0 . eS7CQU) JOE* <br />GENERATOR'S/OFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name, ard are classified packaged, <br />marked and labeled/placarded, 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 <br />Exporter, I certify that the contents of this consignment conform to the terms of the attached EPA Acknowiedgment of C,,, ant. ... _ <br />I certify that the waste minimization statement idyll' In 4 2,, a if I am a large ly generator) or jor am a s dity riseratore. <br />Ge.nerato ' Offeror's Printed(Type itiiii ../ '1 ' Signatu -i' ..-41. Month Day Year "" ,A — 0......--- _ <br />ecar/al <pments <br />i— <br />M <br />Import I S. Export from U S Port . • ntrylexit: <br />Transporter signature (for exports only): te leaving US.: <br />D5 17. Transporter Acknowledgment of Re- of Materials <br />Trans Printeryped Najne J i <br />/S <br />Signatur /1# Month Day Year TRAItSPORTE .--- <br />. 6116 iq,/,_t:I--* / eri / 1,1.1?at itr7 <br />Transporter Printed/Typed Na innature -- Month Day Year <br />le I -4-- DESIGNATED FACILITY 18. Discrepancy <br />Discrepancy Indication Space Quantity Type Residue Partial Rejection E Full Rejection <br />Manifest Reference Number: <br />Alternate Facility or Generator) U.S. EPA ID Number <br />Facility's Phone: I <br />Signature of Alternate Facility (or Generator) Month Day Year <br />I I <br />19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) <br />1 2 3_ 4 \o--2s <br />20. Designated Facility Owner or Operator: Certification of receipt of hazardous materials covered by the manifest except as nded in Item 18a <br />Pnnipc5.4 .....\\_\,.... P ' with Day Year <br />ii... ------"\..„....._ _ _ <br />EPA Form 8700-22 (Rev 12-17) Previous editions are obsolete. s