COMPLIANCE INFO_2019 - Laserfiche WebLink

Home Browse Search

Please print or type. (Form designed for use on elite (12-pitch) typewrites) Form Approved. OMB No. 2050-0039 UNIFORM HAZARDOUS 1. Generator ID Number 2. Pagel of 3. Emergency Response Phone 4, Manifest Tracking Number WASTE MANIFEST I CAL 0 0 0 4 05 5 05 1 8001424- 011180922 JJ K 5. Generators Name and Mailing Address Generator's Site Address (if different than mailing address) ARAMARK 7679 S. LONGEST. STOCK70N CA 95200 Generator's Phone: 209 234- 0105 . 6. Transporter Company Name n U.S. EPA ID Number . Trmepoder2 ompany Name U.S. EPAID Number 8. Designated Faclllty Name and SiteAddress U.S. EPA ID Number CHEMI CAL WASTE F.?1ANAGEfvIENT, INC. 35251 OLD SKYLINE ROAD C A T 0 0 06 4 0 1 1 7 KETTLEIVIAN CITY CA93289 Facilites Phone: ga. er. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Containers 11. Total 12. Unit 13. Waste Codes HM and Packing Group (if any)) No. Type Quantity WI.NaI. 1' NON RCRAHAZAROOLISX ASTE SOLID �. q 2.. 4 14. Special Handling Instructions andAdditionai Information ` A7 �M;p CCA008852 CHENUREC CONTRACT 0 CCN24117 15. GENERATOR'S/OFFEROR'S CERTIFICATIOW l hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name, and are classified, packaged, 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, Exporter, I modify that the contents of[his consignment conform to the terms of the attached EPAAcknowledgment of Consent I ceriffy that the waste min[mization statement Identified In 40 CFR 262.27(a) (i( I am a large quantity generator) or (b) (if I am a small quantity generator) is true, . Gen . tor Offerrol�nt dName Sign a Month Day Ygea/r ' Vy 1/1 0 cam--. J- 16, International Shipments - F Import to U.S. ❑ Export from U.S, Peg ofe try/exiC Transporter signature (for exports only): Date leaving U.S.: w17. Trans pc(terAcknowiedgmentofReceiptofMatedals, B2 Trampo r Pantedfryped am Z Signature Month Day - Year /j (/ QTransporter 2 PenterhTyped Name Signature Month Day Year W r- 18. Discrepancy 18a. Discrepancy Indication Space ❑ Quanfity ❑ Type ❑ Residue ❑ Pallial Rejection ❑ Full Rejection Manifest Reference Number: 181o. Alternate Facility (or Generator) U.S. EPAID Number J U r+B. Facililyxs Phone: w Igo. Signature of Alternate Facility (or Generator) f Month Day Year Z 19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) ,, ® 1. 2. 3. 4. 20. Designated Faclllty Owner or Operator. Certifica8on of receipt of hazardous materials covered by the manifest except as noted in Item 18a PrinfedfTyped Name .Signature Month Day Year �ItA 1.rV utla I VXL I 0l I42 1 EPA Form 8700-22 (Rev. 3-05) Previous editions are obsolete, DESIGNATED FACILITY TO ormommom STATE (IF REQUIRED)