Laserfiche WebLink
F <br /> Please print or type.(Form designed forum on elle(12-piton)w Miler. Form Approved.OMB No.2050-0039 <br /> UNIFORM NAD�}DQUS Generator ID Number .f 2 Page 1 of 3.Bner9enq Responrse Phone 4.ManifeslTrocking Nmober <br /> WASTE MANIFEST ie : [ I -1.171 :. Q I ®Q 9 S JJ K <br /> 5 Genemlo/s Name and MaJ44ngAddress - Generabfs SfteAddress(d dinerem magmg addn:ss) <br /> l�raLnr1? S-krY(k'l TerNt�/Yt� <br /> aR441 Ai&,tt ©ririd SiacUon CA `C Dir <br /> 6.Transporter 1 Company Name - U.S.EPA ID Number <br /> !Nl C. rri erpC ��} <br /> 7.T er2Company Nar& U.S-FPA IO Number <br /> 8:Deslg ated F;xuW Name end SbMdreae' U.S-EPA m NdmOer <br /> ,11 -r orycZi etvuES <br /> h?o wes �,nk_ feta 11j CA, 9.2-379 Ll ' <br /> Fadi)es Phone: s <br /> ga- 9b.US.DOTDeaription("Proper Shipping Name,Hand Class,ID Number, 10.Conformers 11.Total 12 UnN <br /> HM. and Packing&wp(#any)) 1 / No. Type . Quantity Wt U 13:Warne Codes <br /> Qt Vilak COr=,Ix�s�; �e Lifv1 ,� moS, (Diebc))t zczsl <br /> W IqA 179 , PG- 1993 CER& i; Z 00i <br /> v z l�fln- F2CRA Nazar�,a iafas}� SaEit�, <br /> Fac[IS Csoa,,�; <br /> 3. <br /> U-TEP RECYCLING <br /> RVICES' RIALTO FACILI EPA <br /> 4. #CAD982444481 HAS THE APPROPRIATE PERMIT S) <br /> AND WILL ACCEPT THIS WASTE AS SHIPP <br /> 14.Special Handing Neh tions and Addilional blametion <br /> 9o..1 55- a 1 n-'tea jllv'"6 f-'l4 00602:0710 Ong o nara of me msn uN grad on m)s n,.mrrSt may <br /> 9a•^•a S gp.{ vt-b /�rdL� Fora r 06020'71 � ssmrnnnve dolly oin orwe or other <br /> Q-)C <br /> 15. GENERATOR'SIOFFEROR'SCERTIFICATION:Thereby tledara that the mnfems ofNs wnsgnman are fogy ant ecurawy desr3ed abo✓e PmPar shipping name,ad are clamified;packaged, <br /> marked ant lebdadflaaMO d,and are in all respects in proper mndHon for mireport acardng to app6ceNe International"national goverrvr*ntal ragWa cjrs Hexpart Otpment and I am d*Pdmary <br /> Egwrer l certify that u e contents of this c,,*nmerdcuNorm tell*terms d th e0acired EPAAdmowletlgmem of Ca tawL <br /> Ic_artitythatthe'rasle mminiv_adort slahmem iden6§etl in 4D CFR 28227(a)'@Ilemalarge gaantl(y generak�or(b)(�flamasme9 uaNity genamlorJ is hua. - <br /> 5 e Pd d am Monty Dey year <br /> 11 A/6 t1w '0 L 1 <br /> ❑I ou. ❑Eiprtim.U.S. Pmt ofenhylexlt <br /> Trensporter st�ahae(torercpods only} Date leaing US.: <br /> w 17.TmmponerA*mledgmentaf ROD Wm Malenials <br /> K Trans1 Pdm/eN/Typed N 1 Sgpal ond1 <br /> n MDay Year <br /> z 2 PAMed?yped Naine - Sto - .Day Ymr <br /> 18.Dlscrepanry •...�� __ - - — . <br /> 18a.Discrepancy Indication Spix N �RMue p� <br /> �J „ IaJPartlal ReJedlon ❑RAI Rakatlon <br /> L��J�GtN• .m._Ff�f1,t1P��_ 4w.+^m C��'PFT�`�V—AK—AI YlN9TG—i1��4rlliry _ <br /> 18b.Alternate Faatily(or Ge*ialor Manifest Reference Number. yy y37 <br /> f,:; US.EPAm Number <br /> d <br /> ra Facility's Phone: <br /> w 18c Somure ofAltemata FacAlty(or Generator) <br /> w19.Hazardous Waste RepM Management Method Codes Oe,codes for hJmamas a"Je treatment,d*pawl.and rec)rfM systems) <br /> 2. f / . 1 <br /> 9. 4. <br /> 1 20 Daegnated Facblty Ow ar p,,Wr.Ce Mmfi,a *celpt of hazardous materials owered by gm maifest eceplas nded in item i8a <br /> PnnWyped Name swebure Monty Day Year <br /> EPA Form 8700-22(Rev.33-05) Prevlous�d onsamobsole , f ESIGNATEDFACILITY TOGENERATOR <br />