Laserfiche WebLink
p <br /> /ZO <br /> Please print or type;(FN" designed for use on elite(i 2-pitch)typewriter.) Form Approved.OMB No.2050-0039 <br /> r)NIFORM S 1.Generator IO N g2 Pago 1 of 3.Emergency Response Phone 4 Nlan sniacking Number <br /> WASTE MANIFEST 1 I@q 3684778 5077 JJ <br /> 5.Generator's Name and Baling Adams Generators Site Address(If different than maNing address) <br /> QUIR UW T 1 NRD <br /> E I' r" <br /> CA 94M <br /> Genera!Plane:T 610 <br /> 6. Msporter 1 Company am U.S.EPA ID Number <br /> AL CA4309 <br /> 7.Transporter 2 Company Name U.S.IPA ID Number <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number <br /> Diem <br /> COWTON CA <br /> Facility's Phone mmw-7100 CAT 0 8 0 1 3 0 <br /> ga 9b.U.S.DOT Description(mcluding Proper Shipping Nerve,Hazard Class,ID NumW 10.Containers 11.Total 12.Unit 13.Waste Codes <br /> HM and Packing Group(if any)) No. Type Quantity Wt.Nol. <br /> 1. A , X0.0,S, 8 8 2:15 <br /> O X <br /> CD DU G <br /> 2.CD FOR RECYCLING/TREATMENT AT THE ! <br /> OeMENNO/KERDOON FACILITY IN COMPTON, <br /> 3. <br /> PERMITS TO RECEIVE YOUR WASTE STREAM AS <br /> 4. <br /> 1 . HmWKM Instructions and n motion <br /> ) t .T !f 117- <br /> NANO TECH ENV- <br /> SILL TO EWROSM-WEAR PROPER PPE <br /> 15. GENERATOR SIOFFEROWS CERTIFICATION: I hereby declare that the contents of Oft consignment are fully and aaxrraiely described above by the proper shipping name,and are classified, <br /> marked and labeledrplacarded,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 cartify that the c"nla of this consignment conform to the term of the a8achad EPAAckn of Consent <br /> certify that the wade minkrazaiion statement identified in 40 CFR 262.27(a)(N I am a large quaWSpI960 or(b)(d I am a all quan tly generate.)la true. <br /> 0GenanitDesmaroI <br /> s Pdndedrryped Name _, Month ay Year <br /> / v <br /> 1 16.International Shipments <br /> � ❑Import to U.S. ❑Export from U.S. end ./exit <br /> 2 Transporter-WA.(tor exprts ooily): Date <br /> W 17.Transporter of Receipt of Materials <br /> t— Transporter 1 re Day tYear <br /> rf 5 E <br /> ranaporter2 PdntedlTyPMLM= Math Day Year <br /> 16.Discrepancy <br /> 18L Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(o Generator) U.S.EPA ID Number <br /> J ' <br /> u@- Facifity's Phare: <br /> nature of Aitentate Fad I fty cr Crerrere ay <br /> Year <br /> 19.Hazardous Wade Report Management Meth Codes(i.e.,codes for hazard waste treatment,disposal,and recycling systema) <br /> L 2. 3. 4. <br /> 20.Designated Facility,Owner or Operator Certi0ca8on of apt of hazardous materials covered b y the mangy except an_1010A.111111 18a <br /> bOS <br /> Signature ex <br /> .« * r <br /> EPA Form 8700-22(Rev. 5) Previous editrons ardabsolke. ATED FACILITY TO GENERATOR <br />