CO04KEJWY (2) - Laserfiche WebLink

Home Browse Search

Form Anyroved. OMB No. 2050-0039 A Imaaupm,,u1J, UNIFORM HAZARDOUS WASTE MANIFEST 1. Generator ID Number r7 A 5 :7, '..", C ':!, 0 2 0 7 2. Page 1 of 1 3. Emergency Response Phone 893-s77- 7 -,1'.i!- 4. Manifest Tracking Number 021324694 JJK Generator's Name and Mailing Address Art: mapife;t i;-:ecei,,,nc( Generator's Site Address (if different than mailing address) Union Pacific Railroad do C3F-ID 'Union Pacific! Railroad 6620 Corporate Dr. 833 E f-ith Street Indianapolis IN 46278 1 Stockton CA 5.520i3 Generator's Phone: a 4 P. '., it it n 4 n _ _ _ 5 Transporter 1 CompaniNante - U.S. EPA ID Number Atileri c;an Integrated Servirii'5, Incl. ICAR0no ,. 4 E: 3, ',,_:,.. '-'; Tra orter 2 Company Name a IT4 -1. 0 \01.--Viellik / - • s . LIA e_ u S iPAl Number . Designated Facilit me and Site Address U.S EPA ID Number Crosby & Overton. Inc. -11530 W. 17th StTPet. Long Beach C:A El08.13 Facility's Phone: I C: .4 1- II 7 I. ...i 11 P ri 1 q zi r_ 52 5445 Oa. 9b. U.S. DOT Description (including Proper Shipping Name. Hazard Class, ID Number, 10. Containers 11. Total 12. Unit 13. Waste Codes KA and Packing Group (if any)) No. , Type Quantity kVt.Nol. ce Non-RCRA Hazardous Waste. Liquid (Used CA D o .....,- R 0 0 1 DM 2- 5- r-i Z tu u.i CD 14. Special Handling Instructions and Additional Information Alwaye Wear Appropriate PPE when handling wamte_ Weight or volume are approximmze. Sh_l_ Profile Number: 117261 AI5 Job Number:79020-117 W142522 15 GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name, ant are classified, packaged. 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 Exporter, I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 26227(5) (if I am a large quantity generator) or (b) (if I am asmall quantity generator) is true. v Generator's/Offeror's Printed/Typed Name Signature i4i Month Day Year it.elelvnda BorreAo on behalf of UPRR 1 1/2 1 I CJ 20 _..1 16. International Shipments El Export from U.S Port of entry/exit. ,- Transporter signature (for exports only): impart to U.S' Date leaving U.S.: !". 17. Transporter Acknowledgment of Receipt of Materials IRANSPORTE Transporter 1 Printed/Typed Name Signature Month Day Year (0/1.4?&-2-172 714N7Apk) I . 1;441.'. Trans r 2 Printed/Typed Name . Signature Month Day Year 112_11k lit- )--- 4- DESIGNATED FACILITY --)' 1 18. Discrepancy Discrepancy Indication Space LIIQuantity Type LI Residue LIII Partial Rejection LII Full Rejection Manifest Reference Number Alternate Facility (or Generator) U.S EPA ID Number Facility's Phone: 1 Signature of Allernate Facility (or Generator) , I I Month Day Year 19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) 1. I V 2. _II 3. 4. 20. Designated Facility ner or Operator: Cedifica ion of receipt of haz rdous materials covered by the manifest except as nded in Item 18a Printed/Typed Name 0 / . Signature Month pay, 2Y23 . 1-/ F1,1------- 1 .................... .... 0_ ST,/ ••••, r• II e_ _ nell uirre•T OV67011/1 • EPA Form 8700-22 tRek11:1.71 Previous editions are obsolete ' /