COMPLIANCE INFO_2021 - Laserfiche WebLink

Home Browse Search

ER I Please print or type. Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3:Emergency Response Phone 4:Manifest Tracking Number WASTE MANIFEST C'AD981663 107 1 (87 7) 577-2669 013105090 F L E 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) Ppp €?fay= #710 Pep 13kivs#710 (0-,•09) 464 -6066 E345 Dr- M.L.N.inq ter w Al vel 845 Dr.M.+ Nta nth Jr. Al k d Generator's Phone: Stockton, CA 9 21216 Stockton, CA 95200„;, 6.Transporter 1 Company Name U.S.EPA ID Number i3teric r.le S-pecialty Waste Sol:+.ttaons Inc "INSMel11@9 4 7.Transporter 2 Company Name U.S.EPA ID Number f 8.Designated Facility Name and Site Address r u , U.S.EPA ID Number General Environmental Mgt, 1 I_f^ 11855 White Rock Road Rancho Cordova, CA 95742 Facility's Phone: C31,63510980CAD980884183 ga 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13;Waste Codes HM and Packing Group(if any)) No. Type Quantity Wt.N01. X 1 UN1950, Waste Aerosols, [flammable. (each not I DF 00127 P 21 i 1DO@ Ii exceed-ing 1 L capacity)] 2. 1, ERG#126 Z 2. LU CD 3. 4. 14.Special Handling Instructions and Additional Information 1.78 371(Ae '�soi�, Flammable) ; i 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;and are classified,packaged, marked and labeled/placarded,and are in all respects in proper condition for transport according to applicable international and n governmental regulations. 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 was minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I sma quanti gene tor)is true. Generator's/ or's rin ITypgd-Name Signature Month Day Year t ' (< 4� i 1 0 16.International Shipments , i= ❑Import to U.S. ❑Export from U.S. Port of entry/exit: 91 Transporter signature(for exports only): Date leaving U.S.: W 17.Transporter Acknowledgment of Receipt of MaterialsLU _ Transporter 1 Printed/Typed Name Signature Month Day Year a Kristo h Y AlrodiiZe 1 1 lt7 f71 Z Transporter 2 Printed/Typed Name Signature Month Day Year F 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity Type j j ❑T ❑.Residue El Rejection El Reaction Manifest Reference Number: F 18b.Alternate Facility(or Generator) U.S.EPA ID Number V ua. Facility's Phone: W 18c.Signature of Alternate Facility(or Generator) Month Day Year Z i v519.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) � 1. 2. 3. 4. 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Printed/Typed Name Signature _ i / `, M nth Day_ Year EPA Form 8700-22(Rev.12-1Previous editions are obsolete. DESIGNATE FACILITY COPY IF YOU RECEIVED THIS MANIFEST,YOU HAVE RESPONSIBIL�rik UNDER THE e-MANIFEST ACT.SEE INSTRUCTIONS ON REVERSE SIDE.