Laserfiche WebLink
I <br /> J t ^r.• 5 <br /> ... i 1 IV <br /> 11111 lease tint or Flrn designed for use on elite 12•pit wrier.) Form proved.OMB No,2050-0039 <br /> II UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4. nIi hacking Number <br /> CA.at�,���n 1 600.713-�40JJK <br /> WASTE MANIFESTy�q� i <br /> S,%Y&.P 56,rtiVCNSi-Ift M1M1 Generator's Site Address(if different than maliin ad less) <br /> 1e4ct <br /> NAI,"(DRIVE <br /> STOCKION.Ci6 <br /> Generator's Phone: <br /> 6.TransppooMer 1 Company Name U.S.EPA ID Number <br /> C'idrVolJ)P.-lit , .,i..;:. :.. t''-:r <br /> 7,Transporter 2 Company Name U.S.EPA ID Number <br /> B, ~,L M96WAddresa U.B.EPA ID Nu,nyer <br /> r W NORTH AL,.MEOA 31REEI r^k 13 2 <br /> COMptioN,CA f1t02Y2 <br /> Facili 's Phone: <br /> go, 9b.U.S.DOT Desorption(Including Proper Shipping Name,Hazard Class,ID Number, 10.Centel am 11.Total 12.Unit <br /> 13.Waste Codes <br /> HM and Packing Grace(if any)) No. Type Quantity Wt.Nd. <br /> 1, N HAZAtiCIOUS WASTE <br /> 0CC <br /> w <br /> out <br /> 2 fTpS WASTE STREAM HAS BEER MALMED <br /> FOR RECYCLING/TREATMENT AT THE <br /> 3. Y IN COMPTON, <br /> CALIFORNIA.THIS FACILITY HAS THE NECESSARY <br /> PERMITS <br /> QMRM WR EPA NUMBER IS CAT0800= <br /> 14.Spe I HgndliRInstruclipAn ddRane Information <br /> l L/liWAIWVvV;\ICR Elf ,........... ... ...-..... .0»:W :..,,.. .� I_ (jY"Y . . ... <br /> ..AR GLOVES AMD EYE PROTECTION. 24 HOUR EMERGENCY CONPA.CT CHEMTREC 424,M3N- „ND CHICO DRAIN OIL 5ERkACE <br /> 1904734-9043 <br /> 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, <br /> marked and Iabeled/placerded,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 <br /> Exporter,I certify that the contents of Mie consignment conform to the tome of the attached EPAAcknowledgmgniofConsent. <br /> I cert that the waste minInnhirun statement Identified In 40 CFR 26227(a)(if I em a large quantity genera )a(b)(If I am a smell quantity generator)Is true. <br /> GeneretorelOfferors Firms Twed Name Wre Mon Day Year <br /> Cj <br /> J 18.InternetlonalS Ipments <br /> Import to U.S. - ❑Export tram . . Pori ofentrylexil: ,=- <br /> Transporter signature(for exports only): Date leaving U.S.: <br /> 17.TmnsponerAdTowledgment of Recolpt of Malerlels -� <br /> GTransporter 1 Pdntedrryped Name /// Signature ✓ �i;1 Mont Day Year <br /> -I— <br /> Transporter2 P me yped Name Signature Mont Day Year <br /> ♦ 18.Discrepancy <br /> 18e.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> V <br /> ser Facility's Phone. <br /> aaC,yl 1Be.Signature ofAltemate Facility(or Generator) Month Day Year <br /> FZ <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,odes for hazardous waste treatment,disposal,and recycling systems) <br /> 1. 2. 3. 4. <br /> -HO <br /> 2J Designilsid Facility Owner or 0 retor.Certification of receipt of hazardous materiels covered by the manffest except as noted In Item tBe _ <br /> nt t ped Name Signature /� Year <br /> 109104107 <br /> EPA Fo m 00- 2(Rev.3-05) Previous editions are obsolete. ;4 <br /> I — ":�- —DEOMATED FACILITY TO GENERATOR <br />