COMPLIANCE INFO_2023 - Laserfiche WebLink

Home Browse Search

Please print or type. Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2 Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST i. O 0 0 4 4 441 4 S 002115350 VES 5.Generators Name and Mailing Address Generator's Site Address(d different than mailing address) EWGA=WA70EMX=VIlXr ML CA 904 Generator's Phone: Zo 6.Transporter f Company Name U.S.EPA ID Number R I D 0 A 11 6 3 3 3 0 9 7,Transporter 2 Company Name U.S.EPA ID Number - C A T Q 0 0 6 S 4 24 1 B.Designated Facility Name and Site Address U.S.EPA ID Number Facilitys Phone: ' CA Owl C A T 0 A O 0 1 4 0 7 13 ga. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Ctass,ID Number, 10 Containers 11.Total 11.Vnit 13.Waste Codes HM and Packing Group(if any)} No Type Quantity Wi.Nol. o 13 F ISO P 2. PWV44MA WARD=VA= WM� LLJ KOM c� 2 D Id 360 3. �$ 9 14.Special Handling Insbuctions and Additional Information 100ft. t br LUXIatm R�illlu_._ f '. 41t . itT`� VIW0�1AC !UM 2)WMW14 A $K 7 Sifal 5 A�1�142?� 15 GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,arta are classified,packaged, marked and labeledlplacarded,and are in all respects in proper condition for transport aocadirg to applicable international and national governmental regulations.If export shipment and I am the Primary Exporter,I certify that the contents of this consignment oonform 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)i dl am a small quantity generator)is true. GeneratorslOfferors Printed 6ped Name Signature Month Day Year e 'L- 1 12 8 16 International Shipments F ❑Import to U.S ❑Export from U.S Port of entrylexit ? Transporter signature(for exports only): Date leaving U.S.. Ir LU 17 TranspaterAcknowledgment of Receipt of Materials Transporter 1 PrintedrTyped Name Signature Month Day Year 4z Transporter 2 Printedlryped Name Signature Month Day Year a w 18 Discrepancy 18a Discrepancy Indication Space ❑ o"fity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest ReferenceNumber: 18b.Alternate Facility(or Generator) U.S EPA ID Number U LL Facilitys Phone- ttk Day Year LL, 18c Signature of Alternate Facility(or Generator) Mon a Z 19.Hazardous Waste Report Management Method Codes(i.e. codes for hazardous waste treatment,disposal,and recycling systemsl G t. 2. 3. 4. 20.Designated Facility Owner or Operator.Certification of receipt of hazardous materials covered by the manifest except as noted it Item 18a PrintedlTypod Name Signature Month Day Year EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. GENERATOR'S INITIAL COPY