Laserfiche WebLink
GSL SK SHIP# 228576694 <br /> Please print or type. Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1 1.Generator ID Number 2.Page 1 of 3. me R s e P 4.Manifest Tracking Number �+ �+ <br /> CAL0Rt0035948 1 �!- r 4� _�10�'y'ri S K S <br /> WASTE MANIFEST <br /> 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) <br /> First Student 20312 <br /> 1005 Navy Dr <br /> STOCKTON CA 9W@6-1142 <br /> Generator's Phone: 513-419--3315 <br /> 6.Treopporter 1 Company.NagSYSTEMS INC U.S.EPA ID Number T X R0000$1QtS <br /> 7,Transporter 2 Company Name U.S.EPA ID Number <br /> CLEAN HARBORS ENV I ROW .NTAL (iVC INC. MAD039322250 <br /> 8,Designated Facility Name and Site Address GLEAN HARBORS OF W I LM I NSI ON U.S.EPA ID Number <br /> 1737 EAST DENN I STREET <br /> WILMINGTON , CA 90744044429835 <br /> 310-835•-9993 CAD <br /> Facility's Phone: <br /> 9a 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit <br /> HM and Packing Group(if any)) 13.Waste Codes <br /> No. Type Quantity Wt.Nol. <br /> 1. NA3877HAZARDt1Ufi WASTE, SOLID N.D.S. $ 1)F' <br /> o , (BAR 1JIM, CHROM I LI M), 9, PS 111. -_ - <br /> w <br /> z 2. <br /> w <br /> CD <br /> 3. <br /> 4. <br /> I <br /> 14.Special Handling Instructions and Additional Information TSD i W I -'SG <br /> I)ERG#171• <br /> C4H EMER6tW,''Y#800--468-•1760-CH/St(/TFI--Cantract retained by generator confers agency author: <br /> on initial transporter to add or substitute additional trans carters on gene behalf <br /> 15. GENERATOR'S/OFFEROR'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, <br /> malted 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 I am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. <br /> I certify that the waste minimization statement identified in 40 CFR262.27(a)(if I am a large quantity generator)or(b)(if I am a small quantity generator)is true. <br /> Geneeratt s/Offeror's Printed/Typed Name Signature Month Day Year <br /> J 16.International Shipments <br /> ❑Import to U.S. ❑Export from U.S. Port of entry/exit: <br /> ? Transporter signature(for exports only): Date leaving U.S.: <br /> W 17.Transporter Acknowledgment of Receipt of Materials <br /> Transporter 1 Printed/Typed Name Signature Month Day Year <br /> a- i <br /> TransporterZ Printed/Typed Name Signature <br /> ,- �: Month Day Year <br /> < <br /> H <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> LL Facility's Phone: <br /> Lu 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> Q <br /> z <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> p 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 /> Printed/Typed Name Signature Month Day Year <br /> EPA Form 8700.22 v 1 P yious editions are obsolete. GENERATOR'S INITIAL COPY <br />