COMPLIANCE INFO_2019 - Laserfiche WebLink

Home Browse Search

RECEIVED BY SJCEHD (EF) ON 5/15/19 Please print or type.(Form designed for use an elite(12-1 typewriter.) Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2 P/a�e 1 oiof 3.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST CAL000412178 1Y 408-363-367a 017 3 6 7 3 5 9 JJ K 5.Generators Name and Mailing Address Generators Site Address(if different than mailing address) Cos�aappreI oremuty 9331 1453 VAMACH LN SAN, CA, 95207 Generator's Phone: 6.Transporter 1 Company Name U.S.EPA ID Number ALL CLEAN HAZARDOUS WASTE REMOVAL INC 7.Transporter 2 Company Name U.S.EPA ID Number TEILARRY RECYCLING, INC. 8.Designated Facility Name and Site Address U.S.EPA ID Number RECICLADORA TEMARRY DE MCO CARRETERA_ FEDERAL NO. 2 ME%, SAB PABLO TECATE BC Facility's Phone: 619-270-9453 9a 9b.U.S.D0T Descripbon(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11,Total 12-Unit HM and Packing Group(if any)) No. Type Quantity WLNol. 13.Waste Codes 1. LT91950 WASTE AEROSOLS (Each No Enceeding 1L � 0001 �Dllli 331 pCapacity) , FLA11MADLE, H.0-S 2 .1 \� 1 g -- a V 2. UN19 93, WASTE FLA123ADLE LIQUIDS, N_O_S, (ACETONE, ISOPROPANOL) , 3, PG II D001 1)035 F003a 331 3. UN1479, WASTE: OXIDISING SOLID, H_©_S _ D001 i 141 L (CONTAINS POTASSIUM PERSULFAT'E AND SODIUM y PERSULFATE) , 5 .1, PGIII 1 4. }ION RCRA HAZARDOUS WASTF LIQUID 563 (DETERGENTS -111.7r-OLS) 1 �/j p 14.Special Handing Instructions and Additional Information L �j 1) bG041€13 /Iii � (Aerosol) 2) R ?�{ (Flats Liq) ?) 8 �� i,Lx'aW (OMiCiaer) 4) 8 fl1 2&_ (SRL–CP) PR]IIARY EXPORTER: 11aAARRY RECYCLING INC_ PO#k 12098 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 Iabeiedlplacarded,and are in all respects it 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 a ched EPAAcknowledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if a a large quantity generator)or(b)(if I am a small quantity generator)is true. GeneratorslOfferor's Printed/Typed Name Signature Month Day Year �"l U'' d 2 J 16-International Wenls 1.– ❑Import to U.S. _ Export from U.S. Port of entrylexii: Transporter signature(fpr exports only): Date leaving U.S.: LLI 17.Transporter Acknowledgment of Receipt of Materials Transpo 1 PrintedlTyped Name Signature Morth Day Year a !0 1 Z,4 1 4– rn a Tr port Printed Typed me Si 1 e Mo tih flay Year i ti r V 18.Discrepancy 1-1 18a.Discrepancy Indication Space ❑ Quantityyp ) ❑ ❑T e ❑Residue ❑Partial Re ectien Fuji Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U S.EPA ID Number J U i� Facility's Phone, W 18c.Signature of Alternate Facility(or Generator) Month Day Year a z 19.Hazardous Waste Report Managemem Method Codes(I e.,codes for hazardous waste treatment,disposal,and recycling systems) W el- 21).D l-20.D ig ated Facility Owner or Operator Certification of receip of hazar us materials vered by the manifest except as rolled in Item 18 Printeci Name Signature M nt/h Day Ye EPA Form 8700-2278v.3-05) Pr vious editions are obsolete. DESIGNATED I ITY DESTINATION STATE (IF REQUIRED)