Laserfiche WebLink
S.. Z' t <br />Please print or ' .. rm desi <br />ned fdr use ort elite 12 -pitch) typewriter.): <br />FormAp roved: OMB No. 20 <br />U4IFORK"AiARDOUS <br />1. Generator ID Number <br />GAL000 <br />2. Page 1 of <br />3. Emergency Response Phone <br />alt nli ummbCberr j�'" <br />aanh0171-45.390 <br />4 <br />WASTE NIANIFES7 <br />OMW <br />t6N371.8747 <br />17 J.3 fY. <br />b. Generellioll4INanne a4MallIng Address Generetoes Ske Address (If different titan malting address) <br />BORE'TECH RESOURCE RECO%t9RY CAW#b� LLC •'+ <br />, <br />16M INDUSTRIAL DR. <br />9TOCKTON. CA 9Wa <br />GeneratorsPhorwy-;im-gAn <br />6. Transporter 1 Conprany.Name M Al A. - '—j � j <br />V.S. EPA 0 Number <br />AAMOS Iff"ONMENTAL SERVICES INC. <br />CADQddOEtif� <br />F. Transporter 2 Company Name. <br />NWkRON1r3MTAL <br />U,&WAVil <br />11;48. Designated Facility Name and Site Address <br />U S EPA 93 Ntartber <br />RAMOS ENVIRONMENTAL SWAACES INC. <br />1151113 S4:tUCH RIVER RD. <br />WEST SACRAMENTO. CA 9se3i <br />Facll sPhone�II& ff-r4i <br />ga <br />9b. U.S. DOT Description Qncluding Proper Shipping Name, Hazard Class, ID Number,110.. <br />Contalnere. <br />tf. TOlel ' <br />t3i lkdl <br />13. Waste Lades <br />HM <br />. so Packing Group (if any)) <br />No. <br />Type <br />1. AIQN RCRA FtAWDt9llS; WA91Z St]{,D PL. DE8RI5). <br />cot <br />_ <br />do <br />r <br />14.8pedal Handl V-Vabnc8ane ertrt of btformetlon :.. . <br />E.R. C014TRACTOR 014140P ENVMNMEDYiA!~ <br />HANDLERS Shi lt.t7f Re,TKAINED AND USE APPROVED. PPE. kk <br />i6. 'GENERATOR%IOFFEROR'S CERTIFICATION: I hereby. declare that lte contents of this eonsignment are fully and, accurately described above by the proper shipping name, and are. dessiffed packaged, - <br />marked and letielad/ptacarded, and are In all respects In proper condition fortransood according to applicable fntemalonel and natbnel.governmental reguli tions. V export al"M and I am the Primary <br />Exporter, l certify that the contents of this consignment conform to the temte of the attached EPA AckrxWedgment of Consent. <br />I aWlt thatthe waste mhrmlzeflon statement IdendW In 46 CFR 262.27(s) Of i am a large quantity generator} or (bj (ff f am a small quantity generator) is hie. <br />faeoeralaralf>Iterors Printed/Typed Name Slgnefiwa <br />Month Day Year <br />47 <br />p' h <br />, <br />-j <br />16. International Stdoments k^ <br />QlmptxttoU.S omUB, ort ofentry/exit: <br />Transporter signature (for exports only): Date leaving US.: <br />as � <br />1W <br />17. TiensporterAd=Wedgntentaf Recelpf of Mebrlek <br />p <br />-Tininsportar# PtintedTT <br />Mot11><. ' . •17�r <br />a <br />Transporter 2 Printed/Typed Nal <br />MtxtQt <br />Z <br />}$e. Discrepancy Indication Specs ❑Quantity ❑Type ❑ Ree Eue <br />L J Peal k*cbori QFdf Re)ee8on' <br />!. <br />Manifest Reference Number <br />t8b. Alternate F <br />U.S. EPA I(Y Number <br />r <br />11. <br />Feclnly's Phone: <br />C� <br />18a Signature <br />14.ell ' <br />— <br />19. Hazardous Wnle Repel mwa9emmt Meltiol thea 4: bodes A:r hazardoua wash treatment disposal. and reeling systems) <br />20. Designated Far1Aty0ilinalor Operator. Certllicafforrofneelpt of hazardous materials oovered by the marl fes! exosilli :rf d01 1*!$0: <br />rittedrryped Name Signalttre <br />EPA Form 8700-22 (Ra 3-0q Previous editions are. obsolete: <br />DESIGNATED FACILITY TO GENERATOR ' <br />