Laserfiche WebLink
nr.,,ee def Ar hma ICmm dncrnnwl frir i ica nn alit. N 5.kfrh1 Nn' Awritar l Form Awroved. OMB No. 2050-0039 <br />EPA Form S/UU-LL (KeQ. 3-05) Previous eamons are oosoiece. UE510NATEU FAf i1Ll 1 Y .I41 Lit:N FiAI Uht <br />UNIFORM HAZARDOUS 1. Generator ID Number <br />2. Page 1 of <br />3. Emergency Response Phone <br />14, Manifest Tracking Number ' <br />0171-45320 JJ K <br />WOTE MANIFEST r-Alwmwsw <br />16-371-6747 <br />8. GeneratarsflJame e1 Melling Address Generators Site Address (if different than mailing address) ' <br />BORE GH RESOURCE RECOVERY CPJ6i a�66r2i A36 LLC i, <br />y <br />1320 MIDUMIAL DR. <br />STOC TON, CA 95719 <br />Generator's Pho _r <br />& Transporter 1 Company Name U.S. EPA ID Number <br />Rr1tv10S EN*JIRdN%AL..V(arES M£. fas(�f3Ad17G1�6 <br />IF. Transporter 2 Company Name U.S. EPA ID Number <br />8. Designated Facility Name and Site Address US. EPA ID Num6ef_; <br />RAMOS Ef•MRONNIEWF L SERIACES INC. <br />151:5 SOUTH PIVER RD. <br />WEST SACRAMEhHO, Cit 95691 <br />FacilitysPhoneial"If-8741 <br />9a <br />9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, <br />tO.,Cbrttakterx <br />11. Total <br />12: Unil <br />t3 Wage. Codes <br />No. <br />Type <br />HM <br />and Pacidng Group (if any)) <br />. Quantity <br />YtrhAfol <br />i <br />1. NON KRA HAZARDOUS WASH SOLID (O$. DXBRIS) <br />cot <br />D&i . <br />p <br />z <br />2. <br />- <br />W <br />A.7 <br />14. Spacial Handling InstruclionivanctAddilliQ Wormatlon <br />1)PROFILE4f ER> M71 <br />E.R. CONTRACTOR: AAMOS' IEMIROMIVIENTAL <br />KAFJDLBM Sr1OULD 8E TRAINED Ar4D USE APPR &D PPE. . <br />:15. 'GENERATOR SIOFFEROMCERTIFICATION: I hereby declare that the dontenls of this consignment are fully and accurately described above by the proper shipping nams, and ere classified, packageQ;'.,� <br />marked and labeledlplacarded, and are in all respects in proper condition for transport according to applicable International and national governmental regulatoneaf exportshlpment and I am the Primary <br />Exporter, I certify 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 Identified in 46 CFR 262.27(a) (if I am a large quantity generator) or (by (dl am a. small quantity generator) is true. <br />Generator's/Mror's Printecir yped Name Signature Month Day Yew-, <br />r <br />116.IntemallonalSm nts❑ Import to U.S. ❑ Export from U.S. ort of entryfexk: <br />-j <br />= <br />Transporter signature (for exports only): Date leaving U.S.: <br />IX17. <br />TiansporterAcknoMedgmentof Receipt of MaterielsUj d <br />jj <br />er <br />Transporter 1 PnntedTT am - — ... - - - . - - _ Sag 1 .: ..I` <br />O <br />a <br />h <br />Transporter 2 PrintedlTyped Name afore Mordh D - <br />_ <br />F <br />18. Discrepancy <br />18a. Discrepancy indication Space ❑ Quantity ❑ Type ❑ Residue Q.Pa iw ❑Full R*dbn' <br />Manifest Reference Number. <br />18b. Alternate Facility (or Generator) UA EFANY <br />FacNty's Phone: <br />.18c: Signature of Altemate Facility.(or Generator) 119x1 <br />19. Hazardous Waste Report Management Method Codes (i.e., codes for Hazardous wane treatment disposal, and recyciing systems) <br />UJI <br />1. <br />2. <br />Facility Owner or Operator: CerthIcatonof receipt of hazardous materials covered by the manifest except as noted In Item 1Be l <br />FDenated <br />SI nature Yearyped Name <br />9 <br />c: � <br />, f <br />EPA Form S/UU-LL (KeQ. 3-05) Previous eamons are oosoiece. UE510NATEU FAf i1Ll 1 Y .I41 Lit:N FiAI Uht <br />