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COYJQOAZE (2)
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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2500 – Emergency Response Program
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COYJQOAZE (2)
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Entry Properties
Last modified
7/11/2023 3:43:09 PM
Creation date
3/10/2023 8:23:50 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2500 – Emergency Response Program
RECORD_ID
COYJQOAZE
PE
2546
STREET_NUMBER
1535
Direction
E
STREET_NAME
PESCADERO
STREET_TYPE
AVE
City
TRACY
Zip
95304
APN
21306046
ENTERED_DATE
2/10/2023 12:00:00 AM
SITE_LOCATION
1535 EAST PESCADERO AVE, TRACY CA 95304
RECEIVED_DATE
2/10/2023 12:00:00 AM
P_LOCATION
03
P_DISTRICT
005
QC Status
Approved
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EHD - Public
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Please print or type 1 Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS ' Genera+or'D Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST CAR000225557 2 800 955-7761 014744405 F L E <br /> S Generstx's Name r-;b'a irg Address Generator's Ste Address!,!Vferent than main nc address) <br /> YRC Inc. dba YRC Freight YRC Inc. dba YRC Freight <br /> 11500 Outlook St. STE 400 -Overland Park, KS 66211 1535 E. Pescadero Ave. <br /> GeneratVs Phone (913) 344-5205 - Tracy, CA 95304 <br /> 6.Transporter 1 Company Name U.S EPA ID Number <br /> PARC Environmental CAR000263707 <br /> JS EPA D <br /> CleanEarthSpecialty Waste Solutions MNS000110924 <br /> 8 Des!godtGd& t�N3rg'nd$rtE&d,ess U.S.EPA ID Nurrbe' <br /> 425 Isis Avenue, Inglewood, CA 90301 <br /> rac' <br /> kry<Pnone. (800) 870-6233 CAD008364432 <br /> 9a 9b U S DOT Desorption(�nduding Proper Shipping Name.Hazard Class.iD Number, 10 Containers it.Totai '2 ,r <br /> HM and Packing Group(if any)) No. Type Quantity "M Vo! 3 Waste odes <br /> LIN1155, Waste Diethyl Ether, 3, PGI (ERG#127) D0011 <br /> X 1 DF �G P 331 --- - <br /> w <br /> UN1263,Waste Paint Related Materials,(Loose Pack), 3, 1)001; <br /> X 11 (ERG#128) 1 DF 100 P 461 . <br /> UN 1789, Waste Hydrochloric Acid, 8, PGII 1)0021 <br /> 2 DF 100 G 701 ;---— <br /> ` LIN 1789, Waste Hydrochloric Aad,8, PGO D00O <br /> X 1 DF 90 G 791 - - <br /> I <br /> 14 S HardLng :-!.�ticnsardAddi:oral Inform , QO <br /> 1. �Yss�e Ether(1x:10 DF oft)Profis# � �1.2G'T" Cougm:war woos OSHA approved <br /> 2.Waste Pah(1x15 o XI-oose Pact)Pro%0 J'4(t.N •40 Pow Pr0°:&"`E "(Pft) <br /> 3.Waste Hydrochlorto Add(2x55xloose Pack)ProHe#t$3N ZT-0 c7 wha0 hwvrwv 1*m ilwWa on thio <br /> 4.Waste HWmd*)rtc Add(ix95x Profle#1931,3US�vC ""'1110" PARC Job&. 153027 <br /> 15 GEN ERATOR'S10FFEROR'S CERTIFICATION: :'hereby declare that the convents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, <br /> marked and iabeledipiacarded,and are in all respects n proper aoindition for transport according to applicable intematronaland 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 die attached EPAAomowtedgment of Consent. <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)(11 am a large quantity generator)or(b)(if I am a small quantity generator <br /> Generato s,01"er rs DnnteG'Typed Name Signature �� Month Day Year <br /> L`-vr ��c ��d1 2 1115 125 <br /> J 16 International Shipments <br /> ~ ❑Import to U.S. ❑Export U 'or,of entry er' <br /> ? <br /> Transporter signature(for exports only)i Date'eavingt,.S <br /> W 17 TrarsporWAdcnowiedgmert of Receipt of Materials <br /> w <br /> � <br /> Transporter 1 PrintediTyped Name Signature Month Day Year <br /> r V Z Z Z3 <br /> CL U �Sc' r <br /> Trarspo'eAr, !edTyped N3.111`1 Month Dam Year <br /> 13 Diso-epancy <br /> 16a.Dismpancy Indication apaceEl <br /> Quantity ❑Type Residue ❑Partial Rejection --J Full Rejection <br /> Manifest Reference Number <br /> fr '3b ARe oa e=ac!'v or Ge erator) U.S EPA ID Number <br /> J <br /> U <br /> FaciI ty's Prone <br /> LU 18c.Signature of Ntenrate Fac,6ty(or Generator) Month Day Year <br /> Q <br /> Z <br /> us 19 Haza.bous'Naste Repot Management Method Codes i.e.codes'or hazardous rite treatment.disposal,and recycling systems] <br /> y <br /> 01 2 H vi l 3. I y I t1 ly � <br /> 20.Designated Facility Owner or Operator Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Printed/Typed Name I� Signature ;� Mcnth Day Year <br /> EPA Fonr 870--22;Rev 12-171 P evious editons are obsolete. DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM <br />
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