Laserfiche WebLink
Please print or type, Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS �.Generator ID Number 2,Page 1 of 3.Emergency Response Phone 4.Manifest Trackin Number <br /> WASTE MANIFEST CAC003DO6889 1 1$$8•S47.2 012 18748 F L E <br /> 5,Generator's Name and Mailing Address GeneraWs Site Address(if different than mailing address) <br /> c USA Irtitec Uc5A <br /> 424 S ii wa 1420 c' irdtec quay <br /> Fresno, CA 97 J Fresno, CA 9370., <br /> Generatar•S Phohe: <br /> 6,Transporter 1 Company Name U.S.EPA ID Number <br /> .Atlas EmAronmeMal Solutions CALOD0435r84 <br /> 7.Transporter 2 Company Name . U.S.EPA 10 Number <br /> 1�\&& _LC,I C R IDqA35��1431 <br /> B.Designated Facilil Name and Site Address U.S.EPA ID Number <br /> US ECOLG�GY NEVADA, <br /> !Ivy 95, 11 Mips SULA of Beatty NV>''330011 DOP0 <br /> _atty, NV 39OW <br /> Facility's Phone: 775-553-24W <br /> 9a 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes <br /> HM and Packing Group(if any)) No. Type Quantity Wt.Nol. <br /> Non-RCRA Hazardous Wa52e, Liquid (Oil) <br /> J 0 � <br /> Z 2. <br /> W <br /> 3. <br /> 4, <br /> 14.Special Handling Instructions and Additional Information ument: D295267 <br /> 1) 070131510-31 W 1 X 51; <br /> 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,ani are classified,packaged, <br /> 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 I am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b) am a small qu94 qua ' gencratoyrp true. <br /> Generator'slQfieror's n(Tyy—a <br /> d Name � Sig Month Day Year'`�-z lif <br /> J 16.International Shipments <br /> F-- ❑Import to U.S. Export from U.S. Port of entry/exit: <br /> ? Transporter signature(for exports only): Date leaving U.S.: <br /> 17.Transporter Acknowledgment of Receipt of Materials <br /> Transporter 1 PrintedlTyped Name Signature Monthh Day Year <br /> a A rj <br /> Y 2 <br /> m 'porter PrinNo <br /> ed Name Signature Month Day Y,Gr <br /> r~ kv lx r y < <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑ esidue El Partial Rejection ❑Full Rejection <br /> L,s>tit �'�au�n Me ,ul a�-�.acr,l�y rec,eIV 4 et—?'S�jr cw 671 <br /> Manifest Reference Number <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J_ <br /> V <br /> Facility.Phone: <br /> w 18c.Signakrre of Alternate Facility(or Generator) Month Day Year <br /> Q <br /> Z <br /> N 1 <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 1, 2, 3. 4. <br /> 20.Des naiad Facility Owner Operatur:CWficatlon of receipt of hazardous materials covered by the manifest excep In Item 18a <br /> rin ywd ame Sig luX, h Day r <br /> EPA Form 0.22(Rev.11W)rfevio&editions are o s te. DESIGNATED FACILITY TO EPA's e-MANIFESf SY T M <br />