Laserfiche WebLink
/Please, <br /> print or type.(Form designed for-.use on elite(12-pitch)tj+petrrtForm Approved.pProved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 11.Generator ID Number 2.Page 1 of 3.Emergency Response Phone4.Manifest Tracid 'Number <br /> WASTE MANIFEST AL00 ):3 57`)7 t b2 Tf� <br /> S.Generator's Name and Malting Address Generator's Site Address(if different than mailing address) <br /> tJINEV'Ef1S,At.-'.SVC QRCYC 1Nf" ,tn'A'lfitc3fn Melld01103 <br /> X32 }s..B Dorado St <br /> %Iovi tori,CA <br /> Generator's Phone: -q%5 <br /> 61 Transporter I Company Name U.S.EPA 10 Number <br /> Union P-a6&�Unes CO <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Fadiity Name and BileAddress U.S.EPA I0 Number <br /> ECD.; rl '�. 4rial 'ti <br /> 1111 West Highway 12S <br /> t---a%T'CvTb0nJF 8#520, SA <br /> Fac11' s P _. <br /> 10 <br /> 9a. 9b.U.S.DOT Desaipfion(including Proper Shipping Name,Hazard Cl ,ID Number, �,. .. 11 Tates Q.Unit 43.blasts Codas <br /> HM and Packing Group( any)) T ,. TY ,. (2uattbiY .._._Wuvol, <br /> � 1 <br /> , C 6 <br /> w. 611 <br /> 2. <br /> 3. <br /> 4 <br /> i <br /> 147Spedol Heading Instructions and Additional Intamation <br /> tit gat.SERMIX RECYC FR <br /> .Mit-RG?ZA ShMd4tr ftSIdue <br /> f-COV, tib 116 <br /> 15, GENERATOR'SIOFFEROR'S CERTIFICATION:I haraba locate that the contents of this cartstgrxnent a fAyarwi eat rarely dated above by the pn*shipping name,and are classified,packaged, <br /> marked and latieladfptacardad,and are in aft respe ds in proper condition for transport accoh ting to appfieabfe jfi add naSonai'govsmmental regulations.if export shipment and I am the Primary <br /> Exporter,I certify that the,contents of Uils o.-ns3griment conform to the terms of the attached EPAAdotovded ti of 6nsant <br /> Icerfify <br /> that the waste min mizat'art statement lddh led m 90,CFR 2S227(a)Cf i am a 1,yge goani#y genekatorr)or(b):Xf om a arsai;10irt ty ;nerator) true. <br /> enerator erots PrInOryM Pam <br /> s 18.Imemationat Shipments <br /> ❑impar to U.S. EJ Expert from U.S. Port of esttryleidt _ <br /> Trans er's'nature for export only): Date leaving U.S.:. <br /> 17.Tr'anspofterAcknvrf3sdgmentotReraipt'ofllQterials <br /> 0. Trans r 1 Printedtf 1 1 i5 <br /> Porta yped Natr� ,y. -, .- r: Y ear <br /> Transporter 2 Pdritedlfypad Name Signature Monm ayear <br /> 18.Oiscrepancy <br /> 18a,Discrepancy Indication$pace 11 Quantify 1:1 Typo ❑Rase. OPardm " DFUIIR.,00n <br /> , <br /> Man""dost Reference Number, <br /> 18b.ktamamFacility(or Generator) 4f S: PAT0f7U" <br /> U <br /> Fad!' s Phone: <br /> UP,; 18c.Signature ofAlternateFacility(or Generator) t #trtih Day Year <br /> 1.., 4 <br /> y18.tiazardousWasteReperiA',aragaltrantMetho;ICodes{.a,rxadestortracardoc�wastetrualment&sPosaj, reGitgsysternsl ,,, , ,,., .,:_. ;. .. . <br /> 2. 3. 4 <br /> , <br /> 20.Designated Certification of receipt oit az2tdops,inateijats tbvared hythe marnfe5t excapt'as nosed In ltani'I�a. <br /> Pr ntadlTyped Name ( S gnature c. Da Year <br /> 1 r 1-7 <br /> EPA Form 8700-22(Rev.3-05) Previous editions-.-re obsolete. SiGN;A CACI , O GENERATOR <br />