Laserfiche WebLink
2800 Turnpike Rd, Stockton Record ID PR0528549 <br /> 3/25/2019 <br /> Photo 1: Manifest number 016870138JJK (1/31/2019)was found without a signed off copy from the destination facility. <br /> Weasa print or Iy m(Form dart ned for use on stile(12-pitch)lym-ler.) Form Approved.OMB No.2050.0039 <br /> UNIFORM HAZARDOUS i.C roman ID Number 2 Pa9a t I 3 E rgency R sponse Phnne d, aml/eet Tracking Number I f�/ <br /> WASTE MANIFEST V V f� <br /> 5 Gene"It,gNam.an4 Mall PgNltlross Generators Sum Address(it dlRerant then malting address) <br /> Generators Phone, <br /> 6.Tran"st?Company Nam. U.S.EPA ID Number <br /> 7.Transporter 2 Company Nam. U.S.EPA ID Number <br /> R.Desigral d Faality Name and Ste Address U.S.EPA ID Nurnber <br /> Facil4y's Phone: <br /> 9a. 9b.U.S.DOT Dascmpten(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Tole, 12.Unit <br /> HM and Packing Group(if any)l 13.Waste Codes <br /> No. TYpe Quantity WLNoI <br /> 1 <br /> aO <br /> w <br /> z 2. <br /> O <br /> 3, <br /> 4, <br /> 14,Special Handling Instructions and Additional Informal— <br /> WOU If'-'iAiI1# 1 s:'e_S(A NALRGer 9l)1 171 FILErY4%1 <br /> 26265 13NR&vAL691 PAPFR FILTERS` 'APPRGPRIATF PPE FyUIPMENT 1 <br /> 15, GENERATOR'S/OFFEROR'S CERTIFICATION:I hereby dedam thattle contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, <br /> marked and Iabeledlplacarded,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 tens of the attached EPAAcknowledgment of Consent. <br /> I bell that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(dl am a small quantity,generator)is true. <br /> Generatot's/O fetors Printed/Typed Name Signature Month Day Year <br /> 16.International Shipments <br /> i ❑Import to U.S. ❑Export from U.S. Port of entry/exit: _ <br /> Transporter signature(far exports only): Date leaving U.S.: <br /> w 17.Transporter Acknowledgment of Receipt of Materials <br /> K Tmnspoher 1 Pdnted7lyped Name Signature Month Day Year <br /> O <br /> N S <br /> QTransporter 2 Printed/Typed Na me Signature Month Day Year <br /> ti a' <br /> 4 F- <br /> -._.i _ 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑Quantity El Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> -- 18b.Attemate Facility(or Generator) U.S.EPA ID Number <br /> U <br /> LL Facilitye Phone: <br /> w 180.Signature of Alternate Facility(or Generator) Mumh Dav Year <br /> Q <br /> Z <br /> h19.Hazardous Waste Report Management Method Codes(i.e..codes for hazardous waste treatment,disposal,and recycling systems) <br /> D1 2. 3. 4. <br /> 1 20.Designated Facility Owner or Operator:Codification of receipt of hazardous materials covered by the manifest except as noted in Item 188 <br /> Printedrryped Name Signature Month Day le" <br /> EPA Form 8700-22(Rev.3-05)Previous editions are obsolete. GENERATOR'S INITIAL COPY <br /> TEPA Form 8700.24(Rev.3A5)Previou$editions 9tbb1581118'Pl:" -- <br /> John Alaniz, REHS Page 1 of 5 <br />