COMPLIANCE INFO_2019 - Laserfiche WebLink

Home Browse Search

Please print or type Form Approved.OMB No.2050-0039 UN[FORM HAZARDOUS I.Generator ID Number 2.page 1 of 3.Emergency Response Phone TTE T ��5�QJJK WASTE MANIFEST C A L 0 0 0 4 0 5 5 9 5 � 800 624-9136 5.Generafnes Name and Mailing Address qqL� L1_OpRI HOFMANNGenerators Site Address(if different than mailing address) ARAMARK UNIFORM AND CAREER APPAREL LLC ARAMARK UNIFORM AND CAREER APPAREL LLC 8130 S MERIDIAN ST 7679 LONGE ST INDIANAPOLIS IN 46217 STOCKTON CA 95206 Generator's Phone: S.Transporter 1 Company Name U.S.EPA ID Number Patriot Environmental Services C A D 0 5 3 8 6 6 7 9 4 7.Transporter 2 Company Name U.S.EPA ID Number 8,Designated Facility Name and Site Address U.S.EPA ID Number CROSBY&OVERTON 1630 W 17TH STREET LANG BEACH CA 90813 Facility's Phone: C A 0 2 8 4 0 9 0 1 9 9a. 9b.U.S,DOT Description(including Proper Shipping Name,Hazard Class,Ip Number, 10,Containars 11,Total 12.Unit 13.Waste Codes HM and Packing Group(if any)) � ) �p ,��y�y No, Type Quantity wt./VOL kill RA2AQ-� Na V � p OCL- kJ1- Z �f -23 S 0L-i D i Eng-PT 00 k DM 2-co r S R � :EM PTY)4. 1 7 NSoLID ( FmPTY) ON 0 14.Special Handling instructions and Additional information USE PROPER PPE JOB # 08-19-00155 1) P) � 3}1 15, GEN ERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consigiifrinent are fully and accurately described above by the proper shipping name,and are classified,packaged, marked and labeledlpiacarded,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 Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. I certify that the waste minimization statement idenfif*d in 40 CFR 262,27(a)(if I am a large quantity generator)or(b)(if I am a small quantity generator)is true. Genet or's110ff/erors Printedlfyj�ed Name Slgnat Month Day Year r1I �� . � ;� 16,International Shipme s Z [71Import to U.S. ElExport from U.S. rt of enirylexit: Transporter signature(for exports only): Date leaving U.S.: LU 17.Transporter Acknowledgment of Receipt of Materials Transporter 1 PrintedlTyped Name Signature Month Day Year vfij.o UP, Z Transporter 2 PrintedlTyped Name Signature month Day Year F^ 18.Discrepancy 1 Be.Discrepancy Indication Space ❑ Quantity ❑ ❑ I ❑Full Rq ction Type Residue Partial Re'ection Manifest Reference Number: h 18b.Alternate Facility(or Generator) U.S.EPA ID Number U if Facility's Phone: LO 18c,Signature of Alternate Facility(or Generator) Month Day Year Z W19.Hazardous Waste Report Management Method Codes(i.e„codes for hazardous waste treatment,disposal,and recycling systems) G 2. 20,Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a PrintedlTyped Name Signature Month Day Year EPA Form 8700.22(Rev.12-17) Previous editions are obsolete. DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM