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<br />UNIFORM HAZARDOUS
<br />WASTE MANIFEST
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<br />1
<br />Emergency Response Phone
<br />(800) 8994672
<br />14. Manifest Tracking Number
<br />0 0 6 8 2 0 9 4 9 GBF
<br />5, Generators Name and Mailing Address Generator's Site Address tif (Menne than moire addreis, R &L CARRIERS R&L CARRIERS 600 GILLAM RD 4143 JESSUP RD VV1LMONOTON OH 46177 , CERES CA 95307
<br />Genera:es Phone 8 0 _O 5 4 3 ..5 6 S. 1 _5_
<br />6. Transporter 1 Company Name U.S EPA ID Number
<br />NRC ENVIRONMENTAL SERVICES INC. ICA R 0 0 0 0 3 0 1 1 4
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<br />Ilea/1y Neale U.S EPA II) Number
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<br />4 I Cinr-o)-v. kw 0 et 0 tq
<br />Fall!
<br />CROSBY
<br />1630W.
<br />LONG
<br />I- i, h 30 and Site Addres., U.S. EPA ID Number
<br />& OVERTON
<br />1781 STREET
<br />BEACH CA 90813
<br />Phone: 562 432-6445 j C A D 0 2 8 4 0 9 0 1 9
<br />ga. 9b US DOT Description (Including Proper Shipping Name, Hazard Class, ID Number. 10. Containers 11 Total 12 Unit
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<br />and Packing Group (if any))
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<br />No Type Quantity VVI.Nol 1) Waste Codes
<br />. N cm-RCRA H a z ardoua Waste, Solid (debris Impacted with Sad-Soft)
<br />0 0 4 DM 2. So
<br />352
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<br />.., ,,,..,:ii I iantlry In uatr , , ded Additional Information
<br />VE AR PROPER PERSONAL PROTECTIVE EQUIPMENT, JOB/ PO# 183016
<br />N:RC ENVIRONMENTAL SERVICES: 1605 TERRY POI NT , ALAMEDA , CA 94501 9B 1 ) PROFILE*
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<br />,s, OENERATOR'S/OFFEROR'S cEwriFiCATioN: !hereby declare that the contents of This consignmeni arc fully and accuiatoly desenbed above by Mu proper shipping name, are are classified, packaged,
<br />marked and labeled/placarded, and are in all respects in proper condition for transport accoroing to applicable international and national gaverninental regulations If export shipment and I am the Primary
<br />Exporter, I codify 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 identiGed in 40 CFR 26227(a) (if tam a Woo quantity generator) or (b) (g1 am a small quantity generator) is true.
<br />. ,Arcrofferries PrinledITYPi.d.ra
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<br />Seztl ...it) Om Year
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<br />16 Infernalhanal Slupment5 ,.-..
<br />to U.S . J Export from U.S Port of entry/exit II Iwo I.
<br />Transporter signature (for exports on 1 Dale leaving U.S :
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<br />1! Transporter Acknowledgment of Receipt of Materials
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<br /> I ;ammeter 1 Printedityrod Name , tt...oh 0:,, , ,
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<br />I r.ir.sv 2 Ponli,MTvryd ',bum! Signature Mnntb
<br />1.. Ck' tit C ii, ,i,k <,-1 ec.i.,c(,_ 1 ya ip-4 122 I 4-- DESIGNATED FACILITY 18. Discrepancy
<br />Discrepancy Indication Space 1-__1. J I Quanti .ty Type Li El Residue El Partial Rejection ri Full Rejection
<br />Manifest Rub:tenon limbo'
<br />Alternate ;.e. illy tor (laneenturl US EPA ID Number
<br />iicd.r, s Phono: I
<br />At. Signature of Alternate Facility for Geri/fakir, ktreith Dan '17,'
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<br />tlazardous Waste Report Management Method Codes ti e , codes for hazardous wastc treatment, disposal, and recycling systems)
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<br />ill Designated Facility Owner or Operator Certification of receipt of hazardous materials covered by the manifest except as tided in Item 18a
<br />,otedttyped Nan' Sarattur -------.f ITAT -17 --
<br />PACil) eAV•CE CZ) I I lb I 21)121
<br />A Form 8700-22 (Rev 12-17) Previous editions are obsolete. DESIGNATED FACILITY TO EPA's e.MANIFEST SYSTEM
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