COMPLIANCE INFO_2020 - Laserfiche WebLink

Home Browse Search

Please print or type.(Form designed for use on elite(12-11 typewriter.) Form Approved,01V No.2050-0039 UNIFORM HAZARDOUS 1.Generator IU Number 2.Page T cf 3.Emergency Response Phone 4.Manifest Tracking Number- WASTE MANIFEST 364 610 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) ABC Transmissions Inc. 193 S . Union Rd , Manteca , CA 95337 Generator's Phone: 209-823-2100 6.Transporter 1 Company Name V.S.EPA ID Number SACRAMENTO WASTE OIL 534 912 7,Transporter 2 Company Name U.S.EPA ID Number A CAR -'00 175 422 8,Designated Facility Name and Site Address U.S.EPAID Number East 13th Street . Yuma, Arizona 5536. Facility's Phone: 928--642-5 38 AZR "00 515 924 ga. gb.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit HM and Packing Group(if any)) 13.Waste Codes No. Type Quantity Wt./Vol. T. o N 1—RCRA IJAZARDOTJS WASTE SOLIDS P (oily Solids) Z 2 uJ 3. 4. 14,Special Handling Instructions and Additional Information /y� s E as L B r } } S 15. 1515h8RATOR'S10FFERDR'$CERTIFICATIONS l3 erebydeclare that the contents of t#fi conslgnment are fully and accurately described above by the proper shipping name,and are classified,packaged, marked and labelediplacarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations.If export shipment and I am the Primary Exporter,r certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 21(if I am a large quantity generator)or(b)(if I am a small quantity generator)is true. Generator's/Offeror.'s PrmtedrTyped NameSignature -` Month Day Year. g 16,International Shipments T - r Z I1J Import to U.S. El Export from U.S. Port of entry) cif: --- Transporter signature(for exports only): Date leaving U.S.: W 17.TransporterAcknowledgment of Receipt of Materials Transporter 1 PrintedlTyped Name Signature Month Day Year Q Transporter 2 PnntedrTyped Name Signat0re f Month Day Year ..,„ 18.Discrepancy t 18a.Discrepancy Indication Space ❑ Quanti - Type ResidUe� tY El ❑ ❑partial Rejection ❑Full Rejection Manifest Reference Number, H 18b,Alternate Facility(or Generator) U.S-EPA ID Number _J V Facility's Phone: W 180.Signature of Alternate Facility(or Generator) Month Day Year a z � azardous Waste Report Managmeni codes4or disposal-,and-recycling systems) - - -- - - - --- - --- - -- — M 1. T-- 3. 4. 20,Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a PrintedlPyped Na'd Signature Month bay Year ONe EPA Form 8700-22(Rev.3-05) Previous editions are obsolete DESIGNATED FACILITY TO GIENER I ATOR