COMPLIANCE INFO_2019 - Laserfiche WebLink

Home Browse Search

SSL SK SNIP# 228243225 P r Please print or type. Form Approved.OMB No.2050-0039 .Generator D Number 2.Page 1 of 3. me R s e P, I,.Manifest Tracking Number UNIFORM HAZARDOUS 1GICAL00$152�d25 � �._;� ' .-� =�'�'�� WASTE MANIFEST 0070403-81 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) JC Trucking Inc 1415 W. Anderson St. STOCKTON CA 95206-0000 Generators Phone: 209'466_'3282 s.Tr �gprjCpmpAn}N2Ipg SYSTEMS INC U.S.EPA ID Number T%R0812 7.Transporter 2 Company Name U.S.EPA ID Number CLEAN HARBORS ENVIE7OWNTAL, SVC INC. MAD032 8.Designated Facility Name and Site Address CLEAN HARBORS ARAGONITE, LLC U.S.EPA ID Number 11I660 NORTH APTUS ROAD A4�A�VITE , UT 84023 435-884-SIN UTD9815 177 Facility's Phone: ga 9b.U.S.DOT Description(including Proper Shipping Name.Hazard Class,ID Number, 10.Containers 11.Taal 12.Unit 13.Waste Codes HM and Packing Group(if any)) No. Type Quantity Wt.Nol. X 1. UN1A2- __ Tf--SODTiIts .HY-DRC)(,1DE,.-..:SOLI-D,.. ._. _._ - _�__ Tti+� TD0021 0 8, � ,z X 2. UN 11823 WASTE SOD I Ute HYDROXIDE, SQL I D, � TP � F 81 PG X 3. UN 182; WASTE SODIUM HYDROXIDE, SMD, � � �1�� P 1002 141 8, EAG X 4. 1 N1238g WASTE METHANOL, 3, PG 11 � DM ? �� P U154 212 14.Special Handling Instructions and Additional Information TSD Q qG 79814127 JC 10836 CSG; 1)ERG#1154.2)ER(3#1.54.3)ERG#154;4I ERS#1 a 1; 24H E t4ERG�NCY#800--4&8-1760•-CH7SK/TEI-Contract retained by generator confers agency authori y on initial transporter to add or substitute additional transporters on a r� tor' behalf. 15. GENERATOR'SfOFFEROR'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 labeledlplacarded,and are in all respects in proper condition for transport according to applicable intemational and national governmental regulations.If export shipment and I am the Primary Exporter,I car*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 262.27(a)(if I am a large quantity generator)or(b)(if I am a small quantity generator)is true. " Generators/Offerors Printedrfyped Name Signature Month Day Y ar # { 9 4� . 16.International Shipments F ❑Import to U.S. ❑Export from U.S. Port of entry/exit: Z Transporter signature(for exports only): Date leaving U.S.: W17.Transporter Acknowledgment of Receipt of Materials �- t- Transporter 1 Printed/Toed Name Signature,. Month Day Year Z Transporter 2 Pfintedffyped Name Signature ��' Month Day Year 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type y ❑Residue ❑Partial Rejection D Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number J U LL Facility's Phone: w 18c.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) LU 0 1. 2. 3. 4. 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 11 ped Name Signature , Month Day Year EPA Form 8700-22 Rqv.12-17 Mous editions are obsolete. GENERATOR'S INITIAL COPY 086�b91�1 i �1 2)M@09127 1827981 3)8600912/1827981 4)8600896/1827957