Laserfiche WebLink
- - -- 12 , ;roc. `� 5q ! <br /> �— <br /> `�wT <br /> Form Approved. OMB No. 2050-003 <br /> Please print or type. (Form designed for use on elite (12-pitch) typewriter.) <br /> 1. Generator ID Number 2. Paget of 3. Emergency Response Phone 4. Manifest Tracking Number <br /> UNIFORM HAZARDOUS 00 011180914 JJ <br /> WASTE MANIFEST C A 0 0 021 0 5 5 9 Gene0r6�s Sile Addre1424 - Mss31. ... enl than malting address) <br /> 5. Generators Name and Mailing Address <br /> ARAMARK <br /> 7879 S. LONGE ST, <br /> STOCFtTON CA 95206 f 9 2' <br /> Generalars Phone: 4 - 0105 U.S. EPA ID Number <br /> 6 T anspoder1 Compan Name _ ! �,/1 � 17 75 <br /> tW) 1Q„)A 5 U.S. EPAID Number L <br /> 7. Transporter 2 Company Name <br /> U.S. EPA ID Number <br /> a B. Deslgna-ed Facility Name and Site Address <br /> CHEMICALWASTE MANAGEMENT, INC , CAT D 0 0 B Q B 1 9 7 <br /> p 65251 OLD SKYLINE ROAD <br /> KETTLEMAN CITY CA 03239 5� �8B 97 i Facility's Phone; <br /> 10. Containers 11, Total 12. Unit 13. Waste Codes <br /> ga 9b. U,5. DOT Descripfion (including Proper Shipping Name, Hazard Class, ID Number, a Quantity Wt.Nol. <br /> HM and Packing Group (if any)) No. Type <br /> 0 NON RCRA. HAZARDOUSWMASTE SOLID p� �,/ R1-� <br /> CPB1�8852 <br /> O C1 � <br /> 3 <br /> W <br /> i C7 <br /> ) <br /> 14. Special Handling Instructions and Additional information <br /> '! 1 . CAB08852 CHEMTRF_C CONTRACT # CCIV2i 117 <br /> b- <br /> 15. GEN ERATOWSIOFFEROR'S CERTIFICATION: IIa.uby declare -hal the contents of this consignment are fully and accurately described above by the proper shipping name, and are classified, packaged, '.. <br /> Part according to applicable International and national governmental regubdons. If export shipment and l am the Primary <br /> marked and labeled/placarded, and are in all respects In proper condition for trans <br /> Exporter, I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgmenl of Consent. <br /> I catty that the waste minimization sta(emenIIdenfified in 40 CFR 262.27(a) (if I am a large quantity 9enerator) or (b) (if I am a small quantity generator) is We. MoDay Year <br /> t Signanth�f ' y <br /> G toesloft rs PrtntedlTyped Name y / -Z & <br /> f 16. International Shipments ❑ Import to .S. ❑ Export from U.S. Port ofenlrylexit: <br /> p— Date leaving U.S.: <br /> kI Z Transporters! lalum (for exports only): <br /> W 17. Transports elnowledgment of Recall or Matedols Month Day Year <br /> p Signature + 7� <br /> 4 Transpodert Prinledlfyped Name 0 ` / l <br /> E a ✓ / yl/1" ) Month Day Year <br /> f Q Tmnsporter2 Pdnled Was Name g ure <br /> p F_ <br /> 18, Discrepancy <br /> Discrepancy Indication Space El Type ❑ Residue ❑ Partial Rejection ❑ Full Rejection <br /> 18a. <br /> .t ❑ quantity <br /> d <br /> Manifest Reference Number: <br /> U.S. EPA ID Number <br /> 186. Alternate Facility (or Generator) <br /> J <br /> U <br /> ua.. Facllil}+s Phone: Month Day Year <br /> w 18c. Signature ofAllemate Facility (or Generator) <br /> a <br /> z <br /> Hazardaus Waste Report Management Method Codes (i.e.. codes for hazardous waste treatment, disposal, and recycling systems) 4 <br /> w 2. 3' <br /> - <br /> 0E = <br /> f 20, Designated Facility Owneror Operator: Cedificallon of receipt of hazardous maledals covered by the mouthed except as noted in item 18a <br /> Signature ®'h ,DAY Yei , <br /> PdnledfTyped Name _ <br /> 1 <br /> 1 ooAa.rn7nn_ev /Ra,� a-nE1 Provierseditionsareobsolete. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRE[ <br /> ,.. <br />