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COZD0T59Q (2)
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2500 – Emergency Response Program
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COZD0T59Q (2)
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Last modified
4/4/2023 2:51:32 PM
Creation date
4/4/2023 2:47:24 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2500 – Emergency Response Program
RECORD_ID
COZD0T59Q
PE
2546
FACILITY_NAME
UNION PACIFIC
STREET_NUMBER
1000
Direction
E
STREET_NAME
ROTH
STREET_TYPE
RD
City
FRENCH CAMP
Zip
95231
APN
19820005
ENTERED_DATE
3/7/2022 12:00:00 AM
SITE_LOCATION
1000 E ROTH ROAD, FRENCH CAMP
RECEIVED_DATE
3/7/2022 12:00:00 AM
P_LOCATION
07
P_DISTRICT
003
QC Status
Approved
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SJGOV\ymoreno
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EHD - Public
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Form Approved, OMB No. 2050-0039 Please print or type. <br />UNIFORM HAZARDOUS WASTE MANIFEST <br />(Continuation Sheet) <br />21. Generator ID Number,..?6/' ,527://e) <br />acaa_ <br />22. P.,.t.:j 23. Manifest Tracking Number <br />7 sAf ce---- <br />Generator's Name <br />C)(r eU 674.6;' <br />-A 0 <br />, ,U4.: ER5t10 Nu rp(f.57:23j799::? --71,is-2,5,...-..---- Transporter -9 Compar 5filir.8---/I7 6 <br />A—t.4e. /1170,1) <br />' U.S. EPA ID Number Transporter Company Name <br />I <br />27a. 27b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 28. Containers 29. Total 30. Unit 31. Waste Codes HM and Packing Group (if any)) No. Type Quantity Wt.Nol. <br />itt o <br />g w z w <br />0 <br />Special Handling Instructions and Additional Information TRANSPORTER I Transporter Acknowledgment of Receipt of Materials <br />PrirlfTyp Nam Sig Month Day Year <br />Transporter Acknowledgment of Receipt of Materials Or I <br />Printed/Typed Name Signature • Month Day Year <br />I I I I r <br />p, <br />0 w <br />Discrepancy <br />, ,,todal---ed 750F Y--, t <br />Tro,n500-tre K. 07- ecur /Id- Clea r <br />LL <br />• 5-/W2_2_, <br />P— Q z <br />0 <br />Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) <br />I I I 1 (7) Lu ca <br />I I / I <br />- .." orrn -(Rev. -17) Previous editions are obsolete. DESIGNATED FACILITY TO EPA's e-MANIFEST S
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