Laserfiche WebLink
016774117JJK <br /> Please print or type.(Form deal ed for use on elite(12-pitch)typewntar.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Gen.eerX sVr 2.Pae loll 3.En���no 1.Manlfaet 7raking Number <br /> WASTE MANIFEfi4132 0167741 <br /> 17 J J y <br /> 5.C,enenyr1rt WYE N"- 11002 C,eneralor's Site Address(ff different lhan mailing address) <br /> POBOX 3191 <br /> MODESTO CA 95354 2714 STAGECOACH <br /> Generators Phone: 209 943.4730 STOCKTON CA 95215 <br /> 6.TrarlspAarAIMbNMENTAL SERVICES U-s• ` 8 2 7 7 0 3 6 <br /> 7.Transporter 7 Company Noma U-S.EPA ID Nurnbor <br /> 8.DesiggMMarld�$)t@,rjQ INC U.S.EPA ID Number <br /> 5375 SOUTH BOYLE AVENUE <br /> LOS ANGELES CA 90058 CAD 0 9 7 0 3 0 9 9 3 <br /> Facility's Phone: (323)277"1500 <br /> 9a. 9b.U.S.DOT Descstption(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 1i.Total 12.Unit 13.Waste Codes <br /> HM and Packing Group(if any)) No. Type Quantity Wtivol. <br /> 1- <br /> � I <br /> DM Z,rr P <br /> w 2' <br /> 3. <br /> I <br /> a. <br /> l <br /> 14.Special Handling Inmcfions and A4difional Intomtation <br /> EMERGENCY CONTACT:CHEMTREC 14MO-4249300 NAERGO 981:171*PROFILE#9B1:P 205533 01 LY SOLID"-PAPER <br /> FILTERS*P5004)0043131*APPROPRIATE PERSONAL PROTECTIVE EQUIPMENT ?07-9 Z-xias 310 a?& — <br /> 15, GEHERATOR'8101'FEROWS CFRTIFiCAT1ON:r hereby dedero Dna1 the canlants alibis wnslgnmonl ars lolly arnd axwzwly dascribso auoye by 0*proper shppmg l*rrs,nrid ane a wWhed,packaged, <br /> marl od and labeladplarafdgd.drd aro in or rospodts in proper canditWn Axlranspporlarxording to app3ratito Inwmatlonat d lint nnal00 r+n,martlaf regedariarrs.If export shipment and lam the Primary <br /> Exporter,t ceO that the wrilente of this consignmeni conform to Urs!arms of rhe sttarhed EPA Actraeladginenl of Ca nl. <br /> I oarhN that the waste minimization stAvnerhl Idodilmd in 40 CFR 262 27(a)(If 1 am a large quantity amara)or(b) am a ame quantity yari fator)is true. <br /> Geor'sr IredfiypodNa nal on1 ay Year <br /> iri 0 2,2— <br /> It Z— <br /> j 18.IntemabonaTShipments <br /> ❑Import to U.S. ❑Export from U.S. Portof entry/ext: <br /> Transporter signature(for euporls only): Date leaving U.S.: <br /> 17.TransporterAclswwledgmenl of Receipt of Materials <br /> Tr~rtor i Pri y Name Sgnawre WrAh Day Year <br /> �, S ogLZ � 7 <br /> Transporter 2 Pn yped Name Signstu Month Day Year <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ puantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number. <br /> 18b.Alternate Facility(or Generator} U.S.EPA ID Number <br /> U <br /> Facility's Phone <br /> w 18c.SignatureoAdtemaleFacility(or Ganandar) Month Day Vear <br /> a <br /> 19.Hazardous Waste Repan Manageaiont Method Codes(i.e.,codes for hazardous waste treatment,disposal,and mcycflnq syslarnsl <br /> LU <br /> G I 2. 3. 4 <br /> 20.Dostpnalan Facility owner or tar:Certification of receipt of hazardous materials covered by the manifest except as noted in Item I8a <br /> nsiura Mh y ear <br /> EPA Form 8700.22(Rev. 05) Prevkma editions are Dbsaiete. DESIGNATEEI AGILITY TO DESTINATION STATE(IF REQUIRED) <br />