Laserfiche WebLink
4h4 41 `TK� <br /> Please print or type, (Form designed for use on,elite (12-pitch) typewriter.) 4 Form Approved. OMB No. 2050-0039 <br /> UNIFORM HAZARDOUS 1. GeremtorID Number 2. Pagel of 3. Emergency Res=11ona14t Tracking Number <br /> WASTE MANIFEST CAL000406595 / �:33a-2JJ <br /> 6. Genemtots Name and Mailing Address Generators Site Address (if different than mailing address) <br /> ARAMARK UNIFORM AND CAREER APPAREL LLC <br /> 7679 LONGE ST <br /> STOCKTOR CYC 96206 <br /> Genem(ots Phone:2M2M4)1 06 <br /> 6. Transporter i Company Name U.S. EPA ID Number <br /> PHILIP V EST INDUSTRIAL SERVICES C,ARD00177627 <br /> 7. Transporter 2 Company Name U.S. EPA ID Number <br /> B.Designated Facility Name and Site Address U.S. EPA ID Number <br /> CHEN11 LD SKYLINE <br /> WASTE [vROADaE�9EIVf INC C,ATC0013340117 <br /> 35261 OLD 8K`!L( f`�JE READ <br /> KETTLEMAN, CA 93239 <br /> Facllltys Phone: 8600-222=2@64 <br /> 9a 9b. U.S. DOT Description (Including Proper Shipping Name, Hazard Class, ID Number, 10, Containers 11 . Total 12. Unit 13. Waste Codes <br /> HM and Packing Group (if any)) No. Type Courtly WLA7ol. <br /> NON N RCPA HAZARDOUS WASTE, SDL4r 1 CM ;' <br /> Qo - --- <br /> I <br /> 4. f <br /> 14. Special Handling Instrctlons andAddltonai Information <br /> PROFILE # Cf ODO852 r� <br /> pout d7? <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name, and are classified, packaged, <br /> marked and laheled/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 <br /> Exporter, I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. <br /> I codify that the waste minimization statement identified In 40 CFR 26227(a) (if I am a large quantity generator) or (b) (If I am a small quantity generator) Is We. <br /> G torsi terors 'ntedrrypet Name Signatu Month Day. Year <br /> r / 17 1 & 1149 <br /> -� 6. International Shipments <br /> F ❑ Import to U.S. ❑ Export from U.S. Pod of entrylexit: <br /> z Transporter signature (for exports only): Date leaving U.S.: <br /> �= 17. TransporterAcknowledgment of Receipt of Materials '.. <br /> w <br /> irens orter 1 Printed/Typed Name Signature Month Day Year <br /> a U^wL�e1 <br /> Transporter Prinledffyped Name Signature Month y year <br /> IX <br /> F <br /> 18. Discrepancy <br /> IBe. Discrepancy Indication Space ❑ quantity [] Type ❑ Residue ❑ Padiai Rejection El Full Rejection <br /> Manifest Reference Number: <br /> 186. Alternate Facility (or GeneraleI) - U.S, EPA ID Number <br /> ; <br /> LL Faclillys Phone: <br /> w 18c. Signature of Alternate Facihty (or Generator) Month Day Year <br /> Q <br /> Z <br /> N19. Hazardous Waste Report Management Method Codes [.e., codes for hazardous waste treatment, disposal, and recycling systems) <br /> 0 1, `` 2. 3. 4. <br /> 20. Designated Facility Owner or Operator: Certification of receiptof hazardous materials covered by the manifest except as note 'n It m l8 <br /> Printed/ryped No Signature th ' Day ear <br /> EPA Farm 8700-22 (Rev. 3-05) Previous editions are obsolete. _ DEslamATEo-.FA' C' 11 8TV TO DPSTIONATION STATE (IF REQUIRED) <br />