COMPLIANCE INFO_2020 - Laserfiche WebLink

Home Browse Search

Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050.0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4:Manifest Tracking Number WASTE MANIFEST 5.Generator's Name and Mailing Address Generators Site Address(if different than mailing address) ABC ansmissions Inc. X33 S. Univ Rd. i�aaateea, CA 95337 Generators Phone: 6.Transporter 1 Company Name U.S.EPA ID Number ESTE 01" 534 91. 7,.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address U.S.EPA ID Number . Services, Inr-. 2730 East 13th Street. Yuma Arizonn 86365 Facility's Phone: 928-642—i 3 ga 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10,Containers 11,Total 12.Unit NM and Packing Group(if any)} 13.Waste Codes No. Type Quantity Wi.Nol. 1. XON-RCRA flALARDOUS WASTE SOLIDS (OILY S07 t 3. ) r $ a 4. I I � 14.Special Handling Instructions and Additional Information USE 7� �a\2`L'L'Y-,1 i.:4,I) USE ra',-. 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, marked and labeled/placarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations.If export shipment and 1 am the Primary Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a small quantity generator)is true. GeneratorstOfferors PtintedfTyped Name Signature Month Day Year _J 16.International Shipments" F_ ❑Import to U.S. ❑Export from U.S. Port of entrylexit:` Z Transporter signature(for exports enl Y1� Date leaving U.S.: LW 17.TransporlerAcknoWedgment of Receipt of Materials .r Transporter PrintedlTyped Name Signature Month Day Year O a Q Transporter Printed/Typed Name Signature '""'4° Month Day Year 18.Discrepancy 18a.Discrepancy Indica@on Space ❑ Quantity El Type ❑Residue ❑Partial Rejection ❑Fill Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number J U ;at Facility's Phone: W 180.Signature of Alternate Facility(or Generator) Month Day Year a 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 0 1, 2. 3. 4. 20.Designated Facility Oprner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a PrintedlTyped Name Signature Month. Day Year EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO GENERATOR