Laserfiche WebLink
Form Atsøroved. OMB NO. 2050-0039 <br />i UNIFORM HAZARDOUS <br />WASTE MANIFEST <br />1. Generator ID Number <br />CAR000225557 <br />2. Page 1 of <br />1 <br />3. Emergency Response Phone <br />800-556-9090 <br />4. Manifest Tracking Number <br />020623089 JJK <br />Generator's Name and Mailing Address Generator's Site Address (if different than mailing address) <br />YRC Inc. dba YRC Freight <br />10990 Roe Ave. Overland Park, KS 66211 1535 E Pescadero Ave <br />Generators Phone: 913-344-5205 - I Tracy, CA 95304 <br />Transporter 1 Company Name U.S. EPA ID Number <br />Ancon Marine I CAD980737068 <br />Transporter 2 Company Name U.S. EPA ID Number <br />L.- ' Ira- IAS'IV)tr60- (J-C I (,44-P-e)t)1) I R',)) ( CS. 2- <br />Designated Facility Name and Site Address U.S. EPA ID Number <br />Crosby & Overton <br />1630 W. 17th St. - Long Beach, CA 90813 <br />Facility's Phone: (562) 432-5445 I CAD028409019 <br />ga 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Containers 11. Total 12. Unit 13. Waste Codes <br />NM and Packing Group (if any)) No. Type Quantity Wt.Nol. <br />Ce <br /> Non-RCRA Hazardous Waste Solid (Debris, Neutralized 181 0 1-, <br />w <br />Hydrobromio Acid) 2 DF 250 P <br />z <br />Lu <br /> <br />a <br /> <br /> <br />14. Special Handling Instructions and Additional Information <br />1. ERG 171 Debris 245g Profile# 116389 <br />., <br />ERG Book In Wide: Wore proper [ q ( Lit14 <br />OSHA approved PPE When Fondling filo <br />rnatedde on this manifoet. Job# 400.13.28539 <br />15. GENERATOR'S/OFFEROR'S CERTIFICATION: thereby 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 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 <br />Exporter, I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. <br />I certify that the waste minimization statement identified in 40 CFR 262.27(a) (it I am a large quantitygengrator) or (b) (Ill am a small quantity generator) is true. <br />Genetor's/Offerors Pr /Typed ame -- Sig4tur pay_ Year <br />_, 16. International Shipments LII Export from U.S. Port of entry/exit: <br />I-- <br />K <br />Im rt o U.S. <br />Transporter signature (for exports only) Date leaving U.S.: <br />Re. 17. Transporter Acknowledgment of Receipt of Materials fRANSPORTE Transsf,er 1 Printed/Typed Name Si ure Month Day <br />2 /K0 <br />Year <br /> 0 ri) I I --C <br />Tra e 2 Printed ped e <br />---7 <br />04"-1/0.-7A-CAA-CL/ I <br />Mon tl Day. Year <br />(Is_ CL... I 0 Yr I ?-1,t---. 14-- DESIGNATED FACILITY -0 t 18. Discrepancy <br />Discrepancy Indication Space LIIQuantity Type LII Residue E. Partial Rejection Full Rejection <br />Manifest Reference Number: <br />Alternate Facility (or Generator) U.S. EPA ID Number <br />Facility's Phone: I <br />Signature of Alternate Facility (or Generator) Month Day Year <br />1 I <br />19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) <br />1. <br />% /I/ <br />2. 3. 4. <br />20. Designated Facility Owner or 0 erator: Certification of receipt of ha- rdous mate '4s Is coxered by the manifest except as nded In Item 18a <br />Printed/Typed NaLmer. Signature Month ., Dao arc. <br />LA-- <br /> <br />I SI <br />A I 1 <br />EPA Form 8700-22 (Rev. 1 - ) Previous editions are obsolete. -