COMPLIANCE INFO_PRE 2019 - Laserfiche WebLink

Home Browse Search

i Please print or pe.(Form designed forum on elite(12-etch)typlrviDbx.) Form Approved.OMB No,2050-0039 UNIFORM HAZARDOUS I.Generator lD Number 2.Paget of 3.Emargeney Response Picone /.Manifest Tracking Number WASTE MANIFEST C A D 4 92 3 5 6 9 d 1 1 00� 4'24-.93UC 008142661 JJ K 5.Gm1l�4fIXIM�' �EtitlY�fiKS - Generators Site Address if different than mailing address) PO BOX 999 tlY b 2373 NMRIPOSA ROAD I LA PORTE TX 77672 STOCKTON CA 95206 Swami Phone: 916 452 Slit 6.Transporter l Company Name U.S.EPA IDNIT, ASBURY ENYIRONNENTAL SERVICES C A 0 2 8 2 7 7 0 3 6 ' i 7.Transporter 2 Company Name U.S.FPA Number S.Desi alert Fadi Name and SiteA�emu U.S.EPA ID Number ' ENENNATER TECHNOLOGIES CORP. 6375 SOUTH BOYLE AVENUE -LOS ANGELES -..-_ 0068--CA 90 9 9 3 Fora P core: 01277-150D gen 9b.U.S.DOT Desaip (IndWMg Proper Shipping Name,Harvard Clan.ID Number, 1D.Contelners 11.1dal 12 Unit 13.Waste.Cocos HM and Paciang Gmup If any)) No. Type Quantity WLNaI. 1. 152y ot3, OOUS WASTE, SOLID(OILY SOLIDS) � Olo P z W 14.Spedal HandlinglnsWdionsand Adchonal omraeom ENEROENCYCONTACT:CHENTREC 1-800-424-9300NAER(3#981 : 171'PROFILE$901 :AP1B1169 OILY SOLIDS, ABSORBENT, SWEEP'PO#A110134550-APPROPRIATE PERSONAL PROTEC1*.E'EQUIPNENT i) / Ul/s 15. GENERATOR'SIOFFEROR'S CERTIFICATION:I hereby declare that the contants of this consignment aro fully and accuretey,described above by Ne Proper slapping name,and are classified.Packaged, marked ala Iabel"placarded,and are In all respells in proper condition for1ranspom according W applicable International and national governmental regulations.If expo:shipment and I am the Primary E)porter,l certify that Pre contents of Nis consignment conform to the terms of rhe allached EPAAcknoMedgmem of Consent. I cently Nat Ne waste m rion.alion statement Identified In 40 CFR 262.27(a)(K I em a large quantity generator)m(b)Oft am a small quantity gen r)is tore. Dey a srOKerofs Prinled/fyped e L J 18.International Shiftieffs ❑import to U.S. ❑Export from US Pon of entry/e _ Dale leaving U.S.: Transports,signature(for exports only): IX Ira 17.TransponerA&j*Wedgment of Receipt of Mai M To t PNt ty v 't ypad Nam Spnature / O 6 Trinsporai Pr. d!T d omasignouture Month Day Year 18..Discrepancy ❑Full Refection Ills.Olscrepanoy lrxfiratlon Space El charity ❑Type ❑Resltlue ❑Pattlal Rejection Manifest Reference Number. 18ternate Fadley for Generator) U.S.FPA ID Number 6.Al J U Fackity's Phone: Monty Day Year W 1&.SignaWra of Alternate Faaity(or Gerereaxj Q Z S2 19.Hazardous Waste Repan Management Method Cellae OA.,oadesforhazallous waste treatment,disposal,and recycling systems) 1. 2. 3. 4. 20.Designated FocONy,6�.—,brqjemtor Certleca8on of neceipt of haramous mallidials covered by the manifest except as noted In Item 18 ggry Day Year `IIIY mwdRyped Name SlgnaNre EPA Form 87*22(Rev.S-D5) revious adirtions are ob le . DESIGNATED FA ITY TO D S IN TION STATE(IF REOUI ED)