Laserfiche WebLink
Form Approved.OM13 No.2050.0039 <br /> Please print or type. F <br /> UNIFORM HAZARDOUS I.Generator ID Number <br /> TG�1_11 3.Emeency Res�onse Phone 4�6yf�� <br /> n °�771 JJKWASTE MANIFESTCA L 0 0 0 2 6 3 7 9 41 SON5-95,8 <br /> G erd 6i "N6T%ARLEY OOOUNG TOVERS Generator's Site Address(if different than mailing address) <br /> 5. <br /> 200 NORTH VAGNERAVE, <br /> STOCKTON CA 95215 <br /> Generators Phone: 2 0 9 4 5 5 - 3 4 5 1 <br /> 6.Transpo ter 1 U.S.EPA iD Number <br /> Company Name <br /> � Y <br /> 7.Transporter 2 Company Name <br /> U.S.EPA ID Number <br /> a.Dt49�6A tWXGEMENT-KETTILEMAN HI <br /> 35251 SKYLINE ROAD <br /> KETTLEMAN CITY C.A. 93239 C A T 0 0 0 6 4 6 1 1 7 <br /> Facility's Phone: 559 368'8289'Tl l ll <br /> gar 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.IVol. <br /> MOIN ReRA <br /> { l <br /> Ir <br /> `J <br /> Lu <br /> W 2 RQ,UN30�I1,ENv 1Rbr`tt'tENTigt ly �„�zRctaouP 1�� <br /> � SNt35tAn1GE, 5o1�h,t4.p,S. I�RSF.tJIc�t q� � y �l'� bra � , <br /> 3. <br /> 4. <br /> 14 Taal Handling Instructions and Additional Information <br /> 1_ Wea= Appropriate PPE when Handling Profile CA615 85 <br /> Filter Cake containing chrome <br /> 15. GENERATOR'S OFFEROR'S C RTIFICATION:1 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 labeiediplacarded,and are in all respects in proper condi ion for transport according to applicable inlemafionaland national governmental regulations.If export shipment and I am the Primary <br /> Exporter,I cedify that the contents of this consignmentcontorm to the torts of the attached EPAAcknowledgment 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)(Ill am a small quantity generator)is true. <br /> Iv Generators Otrterors P nled Typed Name Signature Month Day Year <br /> roan,;r, 0LSPX Al <br /> J ntem nal Shipments <br /> H Import to U.S. ❑Export from U.S. t of entrylex C <br /> ? Transporter signature(for exports only): Date leaving U.S.: <br /> 17.TransporterAcknowledgmenl of Receipt of Materials <br /> 11—hon der 1 Printed Typed Na SignatureMonth Day Year <br /> .Ir <br /> Z Tra porter 2 rm yped Name Signature V Month Day Year <br /> F <br /> 18.Discrepancy <br /> 18a Discrepancy Indication Space ❑ ❑ ❑Partial Re <br /> ❑Quantity Type Residue jecGon ❑Full Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J_ <br /> y.) <br /> LL Facility's Phone: <br /> W 18c.Signature of Altemate Facility(or Generator) Month Day Year <br /> ZZ <br /> F) 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 0 1. 2. 3. 4 <br /> 20.Designated Facility Owner or Operator Cerlificafion of receipt of hazardous materials covered by the manifestexcept as noted in Ilem 18a <br /> Pontudrfyped Hann Signature Month Day Year <br /> �IC f ou D�I I I .Z <br /> EPAFortn 8700.22(Rev.12-17) Previous ed s are obsolete. ESIGNATE ACILITY TO EPA's e-MANIFEST SYSTEM I <br />