COMPLIANCE INFO_2022 - Laserfiche WebLink

Home Browse Search

ei F Please print or type. Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 14.Manifest Tracking Number WASTE MANIFEST u F L E- 5.Generator's Name and Mailing Ad cess i t�ckto ,c:,elGeneratn s Site Address(if different than mailing address) Mckton. County of Soo J�quin lxl lnASSouyofSellbaquin Generator's Phone: 6.Transporter 1 Company Name U.S.EPA ID Number All f_r>isaimomental Sembn LLC =-A- 211863 7.Transporter 2 Company Name U.S.EPA ID Number A16s F.mironm l S€,ktlions :: ttp til+B5220 8. si Hated Facili m Sit Ad s U.S.EPA ID Number n vIV 11r� nr a� � offi o mut t, . Edi g AZL 4 +ZR000 2"78 Facility's Phone: 9a, 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes HM and Packing Group(if any)) No. Type Quantity Wt.Nol. 1. ,LiquidE � 1 Z 2. W 1 3. { I 4. 1 1I Special Handling Instructions and Additional Information 15. GENERATOR'S/OFFEROR'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 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 Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of 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 quantity generator)is true. Generator's/Offeror's Printed/Typed Name Signature Month Day Year 16.International Shipments P- ❑Import to U.S. ❑Export from U.S. Port of entry/exit: K Transporter signature(for exports only): Date leaving U.S.: W 17.Transporter Acknowledgment of Receipt of Materials LU 1Z Transporter 1rPrinted/Typed Name Signature __. _. Month Day Year Transporter 2 Printed/Typed Name /Signature n Month Day Year H 18,Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number J V LL Facility's Phone: W 18c.Signature of Alternate Facility(or Generator) Month Day Year 11z N19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) C 1. 2. 3. 4. 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Printed/Typed Name Signature Month Day Year EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. GENERATOR'S INITIAL COPY