Laserfiche WebLink
1 3 <br /> Please print or type.(Form designed for use on eli, (12-pitch)typewriter. <br /> Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Nuitiber 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST - Q I. 916371-b74z. 1006063904 JJ K <br /> 5.Generators Name and MailingAddress Generators Site Address(if different than mailing address) <br /> STOCMN U.S.D. STAGG HIGH SCHOOL:. <br /> ;. 1621,BROOKSIDE OR: <br /> ,,ST'OCKTON.,CA,95207 <br /> Generators Phone: 2039936157 <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> RAMOS,ENVIRONMENTAL SERVICES „CAD0440133555 . <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> AddMLLM S LLC U.S.EPA Ip Number <br /> 1,125•HENSLEY-,STREET: ;;, „. . . , CAT0W4079 <br /> RICHMOND.Ck 94801 <br /> Facility's Phone:'WCN 243 2382% <br /> ga_ 9b.U.S.DOT Description(including Proper S ipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit <br /> HM and Packing Group(if any)) No. Type Quantity Wt.Nol. 13.Waste Codes <br /> 1. WASTE ENVIRONMENTALY US..SUBSANCES-LIQUIDc,NOS,, <br /> 0 3082,P <br /> 9.UNWI(WATER. LINE) <br /> ci o Drvt 8d 6-7 <br /> z 2. <br /> W <br /> I <br /> 3. <br /> 4. <br /> 14.S2ecial Handling Instructions and Additional Info on <br /> 9&1)PROFILES,i•. ERG4171:HANDLERS.SHOULD.BE;TRAINED;ANMUSE:APPROVEMP.PE: <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 labeled/placarded,and are in all respects in proper condition for transport according to applicable intemabonal and national governmental regulations.If export shipment and I am the Primary <br /> Exporter,I certify that the contents of this consignent conform to the terms of the attached EPA Acknowledgment of Consent. <br /> I certify that the waste minimization statement ide tified in 40 CFR 262.27(a)(d I am a large quantity generator)or(b)(if I am a small quan <br /> IV generator)is we. <br /> GeneratoeslOf7eroes Printed/Typed Name Signatur Month Day Year <br /> Sc <br /> D DQ <br /> ow I- I ztzz-�' <br /> 15.International Shipments <br /> � ❑Import to U. ❑Export from U.S. Pon of enbylexiC <br /> Z Transporter signature(for exports only): Date leaving U.S.: <br /> W 17.Transporter Acknowledgment of Receipt of Materials <br /> Tran rter 1 PrinledfTyped Name Signa Month Day Year <br /> N1¢,~h 1 J so (0 <br /> Q Transporter 2 Pdntedlryped Name Qv Signature Month Day Year <br /> r <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space <br /> ❑ Quantity I El Type ❑Residue Partial Rejection ❑Full Rejection <br /> Manifest Reference Number <br /> 18b.Altemate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> ta+ Facility's Phone: <br /> W 18c.Signature of Nlemate Facility(or Generator) Month Day Year <br /> a <br /> z <br /> N <br /> 19.Hazardous Waste Report Management Method Cods(i.e..codes for hazardous waste treatment,disposal,and recycling systems) <br /> Q 1. 2. <br /> (� l <br /> 20.Designated Facility Owner or Operator.Certification f receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Pd Name S nature l Month Day Year <br /> I -0 /c, <br /> EPA Form 8700-22(Rev.3.05) Previous editions are Absolete, DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br /> 10628.1614 <br />