Laserfiche WebLink
i <br /> I <br /> � IIIIIIIIIIIillllllllllllllllllllll <br /> Please cion i.EGTi7aNIG c;JiTO GENE RAT <br /> type. I COApproved,OMB No.2050.0039 <br /> U141FORM HAZARDOUS 1.Generator 10 Number 2.Page 1 of 3.Emergency Responso PhoneManifest Tracking Number VES C`Sc <br /> WASTE MANIFEST C` A g 0 O 0 2 6 6 2 4 7 1 1 (877)810-0087 r, 001523441 <br /> y <br /> 3.Generator's Name and Mailing Address YUL189A t.3ALVAN I Generatoes Site Address((f different than mailing address) <br /> FED WC GROUND SAMF <br /> 5655 HOOD WAY <br /> TRACY.CA 95377-7217 <br /> Generator's Phone: 209 83045199 <br /> 6.Transporter 1 Company Name U.S,EPA IQ Number <br /> VEOLIA 6S TEC MUCAL SOLUTIC?M N j D 0 8 0 6 3 1 3 6 9 <br /> 7.Tramporfor 2 Company Name n U.S. P ID Nu r [ <br /> 8.Designated Fadlily Name and SileAddress U.S.EPA ID Number <br /> VEOLIA ES TEC$iWCAL SOLUTIONS <br /> 71 DEME AVENUE ' <br /> SALT E1'.I1. 62213114NO <br /> Facultys Phone: 618 271 2804 I L D 0 9 9_ 6 4 2 4 2 4 <br /> Sa, 9b.U.S,00T Oosaiptlon(Including Proper Shipping Name,Hazard Class,ID Number, A Contelnars 11.Total 12.Unit <br /> HM and Packing Group(if any)) i No. Type Quantity gANd. 13.Waste Codes <br /> 0 x 1' M3179,WASTE MJCK z'L.E S POWTIM FOR 9MALL ARMS D0033 331 <br /> F (100 POUNDS OR LESS),(1UC2406070236),A.I.L!RQ <br /> (]3001,D003) 1 C F 9 P DD01 <br /> Lki <br /> z 2. <br /> c7 <br /> 3, h <br /> 4. I <br /> i <br /> 14.Special Handling Instructions and Additianal Information I <br /> 811.Service Catmc6ed by V88T8.+ C:ardaad rrfjinCtt by confers <br /> AA�c�y1►a,rtterlrity on initialto acw or additionalyrs ocr generator's belr , -J- 1 ERQ:133 W:592134 <br /> T11J10fi05921 4 MUD060d r 3 <br /> 15. GENERATOR'SfOFFEROR`S CERTIFICATION: I hereby declareIhat thertl� <br /> lents of tids consignment are fully and accurately described above by the proper shipping name,arra are classified,packaged, <br /> marked and labak d7plecarded,and are in all respects in proper ox fnspod acwding to appticabte intematienatand national govemmental regulations.If export shipment and I am the Primary <br /> Ex arta,I certify that the contents of this consignment conform to the Ia theeattached EPAAdmowledgmenl of Consent <br /> I certify that the waste mlrumlzation statement Identified in 40 CFR 262.27()(d I am a large quantity generator)or(b)(If I am a small quantity generalor)Is true, <br /> GenaratoeslOiferoes PdnlcdlTyPed Name S'n e Month Da Year <br /> W421, <br /> 16,International Shipments 0 1 1 212 1 <br /> F- ❑Impo€t to U.S. ❑Expod from U.S. Port of enWaxit: <br /> A Transporter slgnalure(for exports ony): <br /> Dale leaving U.S,: , <br /> W 17.TransporlerAdmowledgmant of Recelpt of Maiedals I <br /> Lu <br /> Transporter i Pr1nled7fypad Name ; Ey <br /> Month Day Year <br /> O <br /> TreOEL nspan#aSrL2 PdSn1 yped Name nature 0 111 2 2 1 <br /> J J Month Day Year <br /> 18.Discrepancy O <br /> I <br /> 18a,Discrepancy Indication Space ❑ Quantity ❑T7pe ❑Residue ❑Partial Rejection ❑Furl Rejection <br /> i <br /> Manifest Reference Number: <br /> t� 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> U <br /> LL FacillVs Phone; <br /> LLS 18c,Signature ofAllemate Facility(orGenerator) Mon Qay Year <br /> ) <br /> ig.Hazardous Waste Repoli Management Method Codes(i.e.,codes for hazard'us waste lreahnen€disposal,and recycling systems) <br /> © 1' 2• 3, <br /> 4. <br /> 20,Designated Faclgty0mr or Operator.Certd'ication of recelpi of hazardous atedals covered by the manifest except as nded in item 18a <br /> PrudewIypedNama i Signature Month Day Year <br /> U6lf•iA5+O G�3 j j 31 Z <br /> EPA Form 8700 22{Rev.]2-1 revious editions are obsolete. I DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM <br />