COMPLIANCE INFO_2020 - Laserfiche WebLink

Home Browse Search

Please print cr type.(Form deli ned for use of 8ta(1.2 g cf?.'r rewriter.) Form Approved,OMB No.2050-0039 UNIFORM HAZARDOUS ,=->TyrID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST CAL 0 0 0 3 71213 1 1 (800)4249300 017 7 912 3 8 J J K 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) CERTir=iED COWSION CENTER, 7710 MURP,FY DRIVE STOCKTON CA 95210 Generators Phone: 209,93L-L9300 6.Transporter 1 Company Name U.S.EPA ID Number ASBURY ENVIRONMENTAL SERVICES CAD 0 2 8 2 7 7 0 3 6 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address U.S.EPA ID Number US ECOLOGY VERNON INC 5375 SOUTH FOYLE AVENUE LOS ANGELES CA 90058 CAD097O3Q99S Facility's Phone: �� of 7 y ea 9b.U.S.DOT Desuiptivn(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes HM and Packing Group(if any)) No. Type Quantity wu\lbl. 1 NON-RCRA HAZARDOUS WASTE,SOLID(RONDO DUST) ` DM R 3. 4. 14.Special Handling Instructions and Additional Information EMERGENCY CONTACT CHEMTREC 1-800-4249300 WOES TERMINAL CERES CS *PROFILE#981.588536 BOLDO DUST P500-00055128*APPROPRIATE PERSONAL PROTECTIVE EQUIPMENT 15.. GENERATOR'S10FFEROWS CERTIFICATION: 1 hereby declare that the contents of this consignment are fully and accurately described `above'by the propershippi name,and are classified,packaged, marked and labeledlplacarded,and are in all respects in proper condition for transport according to applicable intemationaland.national governmental regulations.I xport shipment and I am the Primary Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAActmowledgment of Consent, I certify that tin6-waste minimization statement identified in 40 CFR 26227(a)(if I am a large quantity generator)or(b)(if I am a s II uanfity generator)is ttu e rotor's/ e Printedffy�ed Namf fir Signature Month Day /Ye j .-J 16.International Shipments I— ❑Import to U.S. ❑Export from U.S. Pori of enbrylexit z Transpotter signature(for exports only): Date leaving U.S.: W 17.Transporter Admowiedgmeni of Receipt of Materials Tran N r 1 Print ype Name Signature .Month Day Year CL a I I< Q Transporter 2 Print ed Name Signature Month Day Year tr 18.Discrepancy 1 Ba,Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Reject(on ❑Full Rejepfion Manifest Reference Number. 18b.Alternate Facility(or Generator) U.S.EPA ID Number U ra Facility's Phone: W18c.Signature of Alternate Facility(or Generator) Month Day Year a z 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) G 1. 12. 3. 4. 20.Designated Facility Owner or Operator.Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Prinledll"yped Name Signature Month Day Year EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITYTO DESTINATION STATE(IF REQUIRED)