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COMPLIANCE INFO_PRE 2019
Environmental Health - Public
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2200 - Hazardous Waste Program
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PR0516718
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COMPLIANCE INFO_PRE 2019
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Entry Properties
Last modified
2/24/2020 11:09:06 AM
Creation date
2/24/2020 9:44:29 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2200 - Hazardous Waste Program
File Section
COMPLIANCE INFO
FileName_PostFix
PRE 2019
RECORD_ID
PR0516718
PE
2220
FACILITY_ID
FA0012753
FACILITY_NAME
MANTECA BULLETIN
STREET_NUMBER
276
STREET_NAME
BUTTON
STREET_TYPE
AVE
City
MANTECA
Zip
95336
APN
20831005
CURRENT_STATUS
01
SITE_LOCATION
276 BUTTON AVE
P_LOCATION
04
P_DISTRICT
003
QC Status
Approved
Scanner
SJGOV\dsedra
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EHD - Public
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Rlease print 61't- e:('c.n designed for use on elite(12-pit, ewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFf' ' HAZARDOUS 1•Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number <br /> ASTEMANIFEST -Q�41�77 �93 002037562 JJK <br /> FTra-n��pmN <br /> n fling Address Generator's Site Address(if different than mailing address) <br /> ,CA MW <br /> 208-249-35n0 <br /> : <br /> ny ame 8 L U.S.EPA IDNumber <br /> CA99M <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> Afho ErMMnMW tW 6erviM CAD0282MM <br /> B.Des' gatyl ed Faafi ne Y S'a Ad resp U.S.EPA ID Number <br /> 5375 S.Boybts AVWW CAM703M <br /> LOS A ow".CA goose <br /> Facilityrs Phone: 323-277-ISM <br /> 9a 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes <br /> HM and Packing Group(if any)) No. Type Quantity Wt.Nol. <br /> 1Nw RM mus WasW,s0W(Wass lr*cortwni obd xft) CF P M <br /> 0d Mone <br /> Z <br /> Z 2. <br /> W <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional Information - <br /> e.Wesal debris,plastic.bucklift.cur*wri tvbd'wb ink 03609*413-- -E"M <br /> i 1 <br /> 15. GENERATOR'S/OFFEROR'S CERTIFICATION: t 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'aacording to applicable international and national governmental regulations.If export shipment and I am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the-terms of the attached EPA Acknowledgment of Consent. <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I-am.a small quantity gen or)i t ue. <br /> [7e� <br /> r's/Offer rs Pdntedfiyped Napre _--Signatur Month Day Year <br /> -J 16.International Shipments <br /> F- ❑Import to U.S. ❑Export from U.S. Port try/exit: <br /> Z Transporter signature(for exports only): �- Dat leav,g U.S.: <br /> LX Acknowledgment Receipt 17.Transporter Ackledt of Ript of Materials <br /> TransppW,l .ed Name Signature Mo t�11ay Y <br /> O (WCL <br /> M Transporter 2 Printed/Ty ed N me Signature,// Months Day Year <br /> F- <br /> 18.Discrepancy <br /> 18a,Discrepancy Indication Space <br /> ❑ Quantity El Type El Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number. <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> Facility's Phone: y <br /> w 18c.Signature of Altemate Facility(or Generator) Month Da Year <br /> Z <br /> U5 19.HazardoustVaste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and regcling systems) <br /> 0 12, 3. 4. <br /> kA��`1 <br /> 20.Designated Fac lity *'er or Operator.Certification o ipt of rdn materials covered by the manifest except as noted in em 1/a <br /> Printed/Typed Name . Signature Month Day Year <br /> EPA Form 8700-22(Rev. -05 Previous editions are o of te. DESIGNAT ILITY TO TD-ETMATION STATE( F REQUIR D) <br />
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