Laserfiche WebLink
-0 <br /> D T S W3_ - 13 - 2 1 <br /> Please print or type.(Farm designed for use on elite(11 241tch)typewriter.) Form Approved.OMB No.2050- <br /> UNIFORM HAZARDOUS I-11.Generator 10 Number 2.Page I of 3.Emergency Response Phone 'racking Number <br /> MANIFEST CALbOD298751 142.1035AX <br /> 5.Generator's Name and Melling Address Generators site Address(if different than mailing address) <br /> F&H CONSTRUCTION <br /> 4945 EWATERLOO RD <br /> STOCKTON,CA 95215 <br /> Generator's Phone; 209-931-3738 <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> SHOP HAZARDS SOLUTIONS CA0000046497 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 1.Dtpo��e6ftW LLC. U.S.EPA ID Number <br /> CAD980884183 <br /> 11855 VMTE ROCK RD. <br /> RANCHO CORDOVA.CA 95742 <br /> Fadlit es Phone: gig—L-35i-wga Bo <br /> 9b.U.S.DOT Description(inducting Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes <br /> HM and Packing Group(d any)) No. Type Quantity -WLNOI. — <br /> 1- RQ,WASTEPAINTR ELATED MATERALS,3,UN 1263,110001.F003) DM P D001 F003 33 <br /> Z 2- NON-RCRA IAAZARDOUS WASTE UQUID DM P 331 <br /> Uj <br /> WATERBASE PAINTS,GLUES <br /> 3. <br /> 4, <br /> jj.,Seg!,I� ndlib instructions and Additional Information <br /> PR <br /> FILE#88089;COMMODITY PACK OIL=BASE PAINTSADHEISIVES,PRIMERS,ERG#128 <br /> 013-2:PROFILE#RB097.COMMODITY PACK.ERG#171 <br /> APPROPIATE PROTECTIVE CLOTH NG <br /> 15. GENERATOR'SIOFIFERORIS CERTIFICATION:I hereby declare that the contents of this consignment are fully and accurateiii described above by the proper shipping name,and are classified,packaged, <br /> marked and labeled1placarded,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 this consignment conform to the terms of the attached EPAAcknowledgment of Consent. <br /> I certify that the waste minimization statement Identified in 40 CFR 262.27(a)Cd I am a large quantity generator)or(b)(if I am a small quantity generator)Is We. <br /> Genera esiolferdes,Printed/Typed Name Signature Month Day <br /> 19 P/ I <br /> P_ El Impo*rt to U.S. <br /> 1 16.International Shipments ❑Export from U.S. Port of entry/exit <br /> Transporter signature(for exports only): Date leaving U.S.: <br /> 17.Transporter Acknowledgment of Receipt of Materials Month Day <br /> Transporter I nSignature <br /> Zyped Name Sign <br /> E2_P1 <br /> AV Month Day Y <br /> Transporter 2 Printed/typed NdAre Signature <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑Type El Residue El Partial Rejection 0 Full Plied-- <br /> Manifest Reference Number. <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> Facility's Phone: Mon ay <br /> 0 Facility(or Generator) <br /> Lu 18c.Signature Of Alternate <br /> Z <br /> 0 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment disposal,and recycling systems) <br /> CA <br /> 3. 4 <br /> LAJ 1. <br /> AP�1 <br /> rian* W i <br /> io.Designated ti6ifiti Owner or 0 CertificationCertification61 receipt of haze -d by tfee except as In RaIIV month Day I <br /> PmrmrWfied Nam <br /> , "Nt watf�3 <br /> EPA Form0-22(Rai.3-05) Previ6us editions are obsolete. dD FACILITY TO DESTINATION STATE(IF REQUIR <br /> WSINATEE <br />