Laserfiche WebLink
Pleese print or type. Form Approved-OMB No.2050-0039 <br /> UNIFORM HAZARDOUS I,.Gen�aiurAlD..du6b60 2 S 5 2 6 2 2.Page]of 3.(���f�s' 678 one 4.Manliest TrkNumber <br /> WASTE MANIFEST LL FF UU 9 4 �i 3 1016114872 F L E <br /> 5.Ge9&0 arM ftd lftb-IONS-STOCKTON Gep&A_VIS eftbdgb1JftUng address) <br /> 1325 EL PINAL DRIVE 1325 EL PINAL DRIVE <br /> STOCKTON CA 95205 STOCKTON CA 95206 <br /> Generators Phone: 406 988 8W <br /> 6.Transporter 1 Compa�y Noma U.S.EPA ID Number <br /> ALL CLEAN I=RDOUS WASTE REMOVAL,INC. C A 0 9 8 2 4 9 2 3 9 9 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.DesignUS ECOLOGY NEVAOASite ress U.S.EPA ID Number <br /> HWY.9511.MILES SOUTH OF BEATTY <br /> BEATTY NV 88003 <br /> NVT330010000 <br /> Facility's Phone: <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 Wt.Nol. <br /> 1. <br /> RQ,UNM,WASTE CORROSNE LIQUIDS,ACIDIC,INORGANIC, 1� t� <br /> o X N.O.S.,8,PG II(SULFURIC ACID.ALUMINUM) O� DF G <br /> Li <br /> w <br /> Z <br /> LU <br /> 3 <br /> 4 <br /> 14, ftftW'TA2W r5'60ANMENT SLUDGE )CA�5C Orf — — <br /> -ACHWO1M1282l19W-C9"BILLTOALL CLEAN PO/IM". <br /> 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, <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[lie leims of the attached EPA Acknowledgment 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)(if I am a small quantity generator)is true. <br /> GeneratofsfCfferoes Printedfryped Name Si,nature Month Day Year <br /> J 16.International Shipments <br /> F ❑Import to U.S. El Export fro S. Port of entry/exit: <br /> ? Transporter signature(for exports only): Date leaving U S-: <br /> 17.Transporter Acknowledgment of Receipt of Materials <br /> Transporter 1 Printed ypad Name Signature 7 MonEdr Day Year <br /> O <br /> CL <br /> z Transporter 2 drded/Typed Name Signature Month Day Year <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue El Rejection ❑Full Rejection <br /> Manifest Reference Number. <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J_ <br /> C.) <br /> ta+- Faclllry's Phone: <br /> W 18c.Signature of Alternate Facility(or Generator) Month Day near <br /> a <br /> Z <br /> y19.Ha ardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> G LLI 1. 12, 3. 4. <br /> 20-Desig atedaci r Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Prin +Typed NameSig Month Day �Year <br /> P 211 1.JILL <br /> U' <br /> EPA Form 700 2 (Rev.12-17) Previous editions are obsolete. DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM <br />