Laserfiche WebLink
-Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 <br /> -UNIFORM HAZARDOUS 1-Generalor ID Number 2.Page 1 of 3.Emergency Response Phone 4,Manifest TrraCKInng Number i <br /> WAS r�1aNlF�sr C A I O G 0 3 71213 1 f800 X24 9300 0 1 ! i 9 2 4 (7 8 Jai <br /> S.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) <br /> CERTEFIED COLLISION CENTER <br /> 7710 MURRAY DPIVE <br /> STOCKTON CA 95210 <br /> Generator's Phone: 209 830-9300US.EPA ID Number <br /> fi,Transporter I Company Name <br /> ASBURY ENVIRONMENTAL SERVICES CAD 0 2 8 2 7 7 0 3 6 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8-Designated Facility Name and Site Address U.S,EPAID Number <br /> DEMENlNO/KEPDOON <br /> 2000 N.AAMEDASTREET <br /> COMPTOiN CA 301222 C A T 0 8 0 0713 3 5 2 <br /> FarWi Phone: 1 y n <br /> 1 <br /> ga 9b.U.S.DOT Description(mciuding Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.V:asla Codes <br /> HM and Packing Group(Ifany)) No. Type Quantity WlNol, <br /> 0 1 NON-RCRA HAZARDOUS WASTE. LIQUID(WATERBORNE PAINT) 3 1✓� <br /> j <br /> D fvt G <br /> LU <br /> i <br /> 3. <br /> 4. t <br /> t <br /> i <br /> 14,Special Handling instructions and AddItonal Information <br /> EMERGEN Y CONTACT:CHENITREC 1-800-4249300 WOES TERMINAD CERES CS NAERG#9151:171 x PROFILE#98-1. : <br /> 426983 WATERBORNE PAINT * *APPROPRIATE PERSONAL PROTECTfVE EQUIPMENT zov�_ <br /> 15. GENERATOR'SlOFFEROR'S CERTIFICATION: I hereby declare that the consents of this consignment are fully and accurately described,above by the proper shipping name,and are ciassr,ed,packaged, <br /> marked and tabeted[placarded,and are in all respects in proper conditon for transport according to appFi able intemational and nat'nal 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 FPAAdmowtedgment of CcWent' <br /> I cerify that the waste minim¢ation statement ident fled in 40 CFR 262.27(a)(if I am a large quantity generalor)yf..(b)(d a quantity generator)is true. <br /> n foeslOfferor's PrinledTfyped Name Moniti Day Year <br /> 1 SA ritematienal3hipments <br /> t- ❑import to U.S. ❑F_xpm from U.s, Pod of entryls;dt <br /> Transpgrterslynatura(for exports only): Data Isaving U.S; <br /> L0'- 17:T44 rkimovvledgmenL of Receipt of Materials <br /> � rranrI Pd� ped NarSignature Month Day Year <br /> Transporter 2Prin ypetl lame signature Month Day Year <br /> F <br /> 18.Discrepancy . <br /> 18a-Discrepancy Indication Space ❑ Cuanti ty Type Residue❑Residue ❑Partal Rejection ❑ <br /> Full Reit--tion <br /> Manifest Reference Number. <br /> 18b.AIlsmate Facility(or Generator) U.S.EPAID Number <br /> U <br /> FaaliVs Phone:. <br /> ju 18e.Signature of Alternate Facility(er Generator) Month Day Year <br /> Q <br /> Z <br /> 1E.Hazardous Waste Reporl Management Method Codes{i.e.,codes for hazardous wasta treatment,disposal,and recycling systamsl <br /> 0 1- 12. 3. 4. <br /> 20.Designated Facility Ownaror Operator.Corl,fication of receipt of hazardous materials mvered by the manifest except as noted in Item 18a <br /> PrintedlTyped Name Signature Mon!) Day Year <br /> r oc c <br /> 97nr_-�o rao.,z nr% o...,.: ., <br />