COMPLIANCE INFO_PRE 2019 - Laserfiche WebLink

Home Browse Search

Please print or type.(Form designed for use on elite(12-x.- ..�ypexlf6en)F• ren..,+ r..;,..••.°, �::v�qnr(�4��i,+.i11 IJr„a vYtir°ud: Form Approved.OMB No,2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number _. 2.Page.1 ot. ,3.Emergpwy Response Phone.' T---0 .hFanH¢z1.Trgs)dnyN.rgnCer I• +._ WASTE MANIFEST C A L 0 0 0 : 4-9300 ©8142:8.5 JJC S.Ganeratofs Name and Mating Address GeneraWs She Address(I dutterent than maul ng address) TRACY CHEVROLET Q&MING - 3400 AUTO PLAZA WAY TRAOY CA! 9630 Generator's Phone: _ 44 d, 6.Transporter 1 Company Name ;• �, - . .,a-•:;:-s . . .. U.S.EPA ID Number• ASBURY ENIARONVENTAL sERVIC - - ::,;=,.:,c• .:V41^1 �;Y�C:� C A D 0 2 8 2 Z T 0 3 6 7.Transporter 2 Company Name -- U.S.EPAID Number je 6.Designated Facility Name and Site AddressU.S.EPA ID Number SIB06 WATER TECHNOLOGIES;CORP. j 6376 SOUTH BOYLE AVENUE LOSM413ELES CA ' i GIM C A D 0 9 7 0 3 0 9 9 3 Facility$Phone: -1600 9a. b.US.DOT Description(including Proper Ship PN9 Nom,Hamid pass,iD Number, .. -.. _ 10.0anleklue-..::.:. .:-41.Total 12 Unit dreu HM and Pag Group(If any)) 13.Waste Codes No. Quantity W11". w 352 , 1. NON-RCRA HAZARDOUS 1 WASTE,SOLID(OILY SOLIDS) . ' � • DM� ISO P LU Z 2. w ra 3. 4- 14.Sp-dal Handling Instructions and Additional Information Efu OENCY CONTACT.CFEMIREC 1.800421 300 NAERGF 981:17�- # 1 01 -POIf: A1101348V wAPPROPRIATE PERSONAL PROTECTIVE EQLNP*NT Al- 15 GENER,4TOR'SIOFFEROR'S CERTIFICATION:I hembydedare that Bre contents of this consignment are fully and accurately described above by the proper shlppbug name,and are classified,packaged, marked and labeledfplacarded,and are in all respects In proper condition for transport according to applicable inlematlonal and national govemmental regulations,8 export shipment and I am the Primary Exporter,I cer*that the contents cd this cars' nt conform b the terms of the attached EPAAcknowledgment of Consenl- I cartfy,that the waste minimization stateme,f 40 CFR 2427(s)(If I am a large quantity generator)or(b)('f 1 a s rani ty tor)Is true. ) Generato rocs Printed/Typed Name Sig UZ9WAIMonth Day Year nn Lt C;-,, ms o rid -j 16.Intemattonal Shipments r— ❑I to U.S. ❑Export from U.S. Port If entry/exit, z Transporter signature(for exports only): Date leaving U.S.: w 17.TransporterAckno-MedgmenlofRecefpt'ufMaleriels Transporter 1Pfailed/TypedName Signature Month Day Year 0 (` ...J d J-I 6Y 11 ZQ Transpoaer2PdnledlTypedName VSignature Month Day Year tr F 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Ful Ree,ton Manifest Reference Number. 18b-Alternate Facility(or Generator) U.S.EPA ID Number J U 1 Fadlitys Phone: . P,yj 18c.Signature of iemate Facility(or Genca:or) Month Day Year z N19.Hazardous Waste Report Management Method Codes(ie.,codes for hazardous waste treatment,disposal,and recycling systems) p 1. 2. 3. 4. ��Al. 1 20.Designated Facility OWner or Op or CerScation of receipt of�!�s rnqWeVAvered by the manifest except as noted In Item Ida Prinled/Typed Name Signature Month Day Year A&o A�z I V)C-;-k--�.I/Z-i EPA Form 8700.22(Rev.3-05) Prbvious ed Icons are obsolete. DESIGNATED F Wry TO DESTINA ION STATE(IF REQUI ED)