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 GercQ*V OuO*3 7 1213 2.Page11 of 3.E-@Sea�i4a2"JbY! 4.Mianifesi Tracking Number <br /> WASTE MANIFEST 11 ll 017 6 9 612 7 JJ K <br /> 5.Gsner Generator's Site Address(if different than mailing address) <br /> 7710 MURR4 DRIVE <br /> 916ci7 <br /> GN CA 9Ki0 <br /> 209 478-9971 <br /> Generator's Phone' <br /> 6.TransliftI&SPE4E.NlEltfi IRONMENTAL SERVICES TR 8 2 7 7 0.3 6 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated FaciVh.�tarrle�od,Site68Ws U.S.EPA ID Number <br /> L2�OtOPdiO�iNV JYALAM EtFbFLA3STURiYEET <br /> COMPTON . CA 90222 CAT080013352 <br /> Facility's Phone: (310)537-7100 <br /> ga. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,JD Number, 10.Containers 1l jbtal 12.Unit <br /> HM and Packing Group(if any)) No. Type Quantity Wt.Nol. 13.Waste Codes <br /> 1. NON-RCRA HAZARDOUS WASTE,LIQUID(OILY{NATER) 223 I <br /> 0 <br /> DP4 G <br /> ur ' <br /> ul 2. j <br /> � I <br /> I <br /> 0 <br /> Ir <br /> 3. i <br /> 4. <br /> r <br /> • F <br /> 14.Special Handling Instructions and Additional Information <br /> EMERGENCY CONTACT:CHEMTREC 1-810-4249300 WOES TERMINAL CERES CS x PROFILE#981:46252018-01 OILY <br /> WATER * *APPROPRIATE PPE EQUIPME=NT4 -�X <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described ab ve 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 applicahte intemabonal an nab oven ental 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 <br /> I certify tha a waste minimization t ent identified in 40 CFR 262.27(a)(Jf I am a large quantity generato all quantity generator)is true. <br /> ene ivr s! a PdntedlTyped Name n u Month Day Year <br /> o <br /> -1 T6.Intemational Shipments <br /> ❑import to U.S. ❑Exportfrom U.S. Port le dt <br /> Transporter signature(for exports only): Date leaving U.S.: <br /> w 17.TransporterAcknowledgment of Receipt of Materials <br /> 0 Tianspo 1 rimtedlTyped cine Signature Month Day Y <br /> 0. <br /> �u l <br /> M Transporter2Printed/TypedName Signature Month Day Year <br /> N <br /> 18.Discrepancy <br /> 18a.Discrepancy ladication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number. <br /> 186 Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> 6 <br /> rds Facility's Phone: <br /> LU h 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> Z <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 0 1. 2, 3. 4. <br /> 20.Designated Facility Owner-or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> PrintedfTyped Name Signature Month Day Year <br /> EPA Form 8700-22('Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE (IIF REQUIRED) <br />