Laserfiche WebLink
Please print or type. Form Approved.OMB No.2050.0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 or 3.Emergency Response Phone Manitast Trac Ing Number <br /> WASTE MANIFEST CAUMU4169 -� 916.37167A7 01917 2 7 5 6 JJ K <br /> 5.Generator's Name and Mailing Address Generators Site Address(d cI ferent than mailing address) <br /> CARANDO TECHNOLOGIES <br /> US N HRRRISON ST. <br /> STOCKI't7N,CA 9621)3 <br /> Generator's Ph2ogaiSAM <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> RAMOS ENVIRONMENTAL SEWCES INC. CADD"003 , <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> Lc. - TYl.I.tJ L.4 IZ c�w 3 H Sb sv <br /> 8.Desigrialed Fadlily Nemeand SlteAddress US.EPA ID Number <br /> PACIFIC RESQURCE.RECOVERY CADQ 2405 <br /> 3150 EAST.PICO 1XV0.. <br /> LOS ANGELES.CA 9W23 <br /> Faclliys Phone:SM'4994145 <br /> ga, 9b.U.S.DOT Dasodptiat{mduding Proper Shipping Name,Hazard Class,10 Numbe, 10.Cor iainers 11.Total 12-Unit 18•yyaste Codes <br /> HM add P.addngGroup(ifaepj)' .No. Type Quaelity WtNai• <br /> 1 (MI1263.WASTE PAWI',3,PGW 42M+ G 331 M' 01 <br /> o: <br /> 55 <br /> W <br /> :C3 <br /> 4. <br /> 14.Special Handlhg InsWclions:andAddi WW Information <br /> �a-1)PROFILe�c �pp`t>;(.�ER61i12I3 <br /> E:R CO 'Ds ENV ONMEWALd 7 <br /> HANDLERS SROM 9E TRAINED AND USE APPROVED PPE /XS� 9&' 7 <br /> 15. GENERATOR'NWEROR'S.CEItTiFICATION:Iherebydedamthat the contents'ofthisc6nsignmen(arstullyandsxuratelydescribed above bygiepropershippiagname,ardare,dassSetl,packaged, <br /> madced and labeledlplacarded,endure In all.respecls in propercirdtlon for transport accenting to applcable Inlenadorra and national govemmenlal regul flops.If export shipmerd'arv!!am the Pe.mary <br /> Exporter,,I certiy that Ore contents of this consignment oMbm to the farms of the allachad EPAAdoawledgmenl ol.Co <br /> I cantly <br /> the waste mudm¢a8on sialemeet identified In 40 CFR 26227(a)Of I am a fame quantity generator)or(bj am aAlgooRgenerator)is true. <br /> Gen' i roes Prmtedffyped Name Signature Month Day Year <br /> _i 16.International Shipments <br /> Import to U.S. ❑Export U of anfrylexlt: <br /> Transporters(gralure(for exports only); Date leaving U.S.: <br /> i7.TrarsporterAdawAdlin antal�eiplorMa <br /> a Transported Pdn We Signa Month Day Year <br /> z Tmnspoder2Pdnfadfryped Sig re Month Day Year <br /> 18:Disampancy <br /> 18a.Discrepancy(ndtoallod8paee ❑ouantity ❑Type ❑Residue ❑ParimRe*w ❑FWIRejection <br /> __ _ Man_ifesPReterenceNumber. <br /> I8b.Allemale Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> rQ+. FadfWsPhone: <br /> F18c..ftnaWre owlemate Facility(or Generator) Month Day Year <br /> H19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste Ineabment,disposal,and recydNgsystems) <br /> p 1 'LA <br /> 12, 3. 4. <br /> rT <br /> 20.Designated Fa ft Owner or Operator.CeAcapon of receipt of hazardous materials covered by the manifest except as noted in Mem 18a <br /> r�5� <br /> Name Signature MonDay.nc,�sorasM&W, _ l <br /> EPA Form 8700.22(Rev.12.17)Previous editions are obsolete. OESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM <br />