COMPLIANCE INFO - Laserfiche WebLink

Home Browse Search

Form Approved. OMB No. 2050-0039 YIII a Pmiror type. lruee uuwyuw me uou cru onw J- F".ur .ry...,.....r 1. Generator ID Number 2. Page 1 of 3. Emergency Response Phone4. Manifest Tracking Number UNIFORM HAZARDOUS 00 4.90 6 FLE WASTE MANIFEST CAC002673069 1 888-785-7225 5. Genemtors Name and Mailing Address Generator's Site Address (if different than mailing address) Rabobank B_A- 635 S Aurora St 1407 Z St Stockton, CA 95203 Modesto, CA 95354 Generators Phone: _ H 31111 6. be sponer 1 anparry Name U.S. EPA ID Number CAR000070540 7. TranspoM1er 2 Comparry Name U.S. EPA ID Number naentel Services Inc- MAD 39322250 8. Designated Fadiity Name and Site Address U.S. EPA ID Number Clean Harbors of San Jose, LLC (San Jose Facility) 1021 T)erryessek Road San Jose, CA 95133 CAD059494310 Facility's Phone: _ ge 9b. U.S. DOT Deacnpfion (including Proper Shipping Name, Hazard Class, ID Number, 10. Containers 11. Total 12. Unit 13. Waste Codes No. Type HM and Packing Group (if amy)) quantity Wt.Nol. 1' tW1263, Waste Paint Related Material, 3, PG Icr P 0001 D035 F003 E005 331 0 % II, RQ (DDDi) /3 x.71 t�v z 2. w C7 3. 4. 14. Special Handling Instructions andAddhonal Information 1) CH522080; RAC -001 -015 C") , ; ERG # = 128 Project Humber_ LV02675 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, and are classified, packaged, marked and .labele fthux rded- and are in all respects in proper condition for transport according to applicable international and national governmental regulations. If export shipment and I am the Primary Exporter, I certlfy, that the contents or this consignment conform to the terms of the attached EPAAcknovAedgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a) (t I am a large quantity generator) or (b) (if I am a small 2ardity generator) is true. neralors/ a s t. ame gna re n ay Year FR+�rcrr 9 6 r 16. International Shipments ❑ Import to U.S. ❑ Export ham U.S. rt of entry/exit: Z � Transporter signature (for ex s only): Date leaving U.S.: 17. TransporterAtnl ckhtriledgmentof Receipt of Maeas K TranspolerI Printedilyped Name 'nature on ay ear rL Aw CAP Za Transporter 2. PnmedlTy Name Signatugli Uay Year K 18. Discrepancy I 18a. Discrepancy Indication Space ❑quantity L1Type❑ Residue ❑ PaNal Rejection ElFullRejection Manifest Reference Number: 18b. Alternate Facility (or Generator) U.S. EPA ID Number J U LL Facili SPhone. w Vic!' ihTmofAlternate Facllity(or Generator) Monti Day Year a z y19. Hazardous Waste Report Management Method Codes (.e., codes for hazardous waste treatment disposal, and recycling systems) /. 2. 3. d. 20. Designated Facility Owner or Operator Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Pdntedffyped Name Signature Month Day Year EPA Form 8700-22 (Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED)