COMPLIANCE INFO_2022 - Laserfiche WebLink

Home Browse Search

Please prim or pe. Forth proved.OMB No,2050.4039 UNIFORM HAZARDOUS 1•Generator ID Number 2.Page 1 of 3.Emergency Response PhoneManf ell Trac not Number WASTE MANIFEST C A R 0 0 0 2 d b 2 4 7 1 22M 18-0087 11001799127 VES 5.Generators Nemo and Mailing Address YULISSA GALVAN Generators Site Address('d different than mailing address) D EX GROUND SAME 655 HOOD WAY RACY, CA 95377-7217 Generators Phone: 6.Transporter 1 Company Name U,S.EPA ID Number VEOLIA ES TECHNICAL SOLUTIONS IN J D 0 8 0 6 3 1 7.Transporter 2 Company Name U.S.EPA ID Number 8.Deslgnaled Facdity Name and Site AddresVEOLIA ES TECHNICAL SOLUTIONS, U.S.EPAiD Number L.L.C. 1125 HENSLEY STREET Facility'sPhone: RICHMOND,CA 94801 IC A T 0 8 0 0 1 4 0 7 9 ga. 9b.U.S.DOT Description(Including Proper Shipping Name,Hazard Class.10 Number, 10.Containers 11.Total 12.Unit 13,Waste Codes HM and Paddng Group(If any)) No, Type Quantity WtNol. Y 1. UN1044, FIRE EXTINGUISHERS CONTAINING COMPRESSED 141 © OR LIQUEFIED GAS, 2,2 1 C Y I P z 2. 1u l7 3. 4, 14.Special Handling Instructtans andAddilional Information ER Service Contrat_ted by VESTS -I- Contract retained by enerator confers Agencg�thoEnt rT n initial transporter to acid ar substitute additional transporters on generator's behalf I- 1 ERG:126 1P.952018 15. OENERATORWOFFEROWS CERTIFICATION:I hereby dedare that the contents of this consignment are fully and accurately described above by tiro proper shipping now,and are ciasslfied,packaged, marked and labeledfplacarded,and are in all respeot5 in proper Condition for transport according to applicable intemationa$and national govemmental 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 EPAAcknoWedgmeniof Consent. 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 quentily generator)is the. GenerstoeslOtferors Printedlryped Name Signature MonthDa Year ,,,j1 .Intemational nts I— ❑import to U.S. ❑Export trom U.S. Port of enbylexit: ? Transporter signature(for exports only}: Date leaving U.S.: 17,TransporterAdqualedgmentof Receipt of Materials TMWrter 1 Pnn Name SnIO D y Year a a z T r 2 nt ams Srgnature Month Oay Y F- 18.Discrepancy 189.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑P9 w Rejection ❑Full Rejection Mandosi Reference Number: 18b,Atlemale Facility(or Generator) U.S.EPA ID Number Zi r� ran. Facility's Phone: w 1tk.Signature ofAltemateFacility(or Generator) Month Day Year a Z 19.Hazardous Waste Report Management Matirod Codes(I.e„codes for haxardeus Waste treatment,disposal,and recycling systems) 8 1. 2, 20.Designated Facility Owner or Operator Certification of receipt of hazardous materials covered by the manifest except as nded in Item 18a FrinteFTV Now Awzn�t�zl Signature �� i �, Maftih sy Year /� �/!/ o z 1 PPA Form 8740-22(Rev.12.17) Previous editions are obsolete. DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM