COMPLIANCE INFO_2019 - Laserfiche WebLink

Home Browse Search

P � PF6� Q ► p- L elm & qj7 Ct/111v1r Please print or type. (Form designed for use on elite (12-pitch) typewriter) Form Approved. OMB No. 2050-0039 UNIFORM HAZARDOUS 1. Generator ID Number 2. Page 1 of 3. Emergency Response Phone 4. Manifest Tracking Number WASTE MANIFEST C ,£1L C1 F 0 4 C1 5 -1 ( RE LID) 424_ Gg 00 ® 1117 ® 633 JJK 5. Generators Name and Mailing Address Generators Site Address (if different than mailing address) ARAMARK 7079 S. LONGE ST. STOCKTON CA @5206 Generators phone: ( 209) 234W E01015 6. Tmnsporler l Company Name U.S. EPA ID Number PWILIP 10r&LzA bb fit & C12 ICAMOD 01 `7 SX �7 7. Transpoder 2 Company Name F U.S. EPA ID Number 8. Designated Facility Name and SibrAddress U.S. EPA ID Number CHEMICALWASTE MANAGEMENT, INC. 35251 CLE) SKYLINE ROAD CAT 0 0 0 0 4 0 1 1 7 KETLEafAM CITY CA 932W Facghtys Phone: go. 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Containers11. Total 12. Unit 13. Waste Codes HM and Packing Group (ff any)) No. Typo Quantity WtdVu. ® 1' NON RCRA HAZARDOUSIMIASTE SOLID 191 M 2. �e 3. 4. 14. Special Handling lnsfmci ons and Additional Information 1 . CA�oe�52 CHEMTRECCONTRACT OCCN24117 15. GENERATOR'S/OFFEROR'S CERTIFICATION: I herebydeciare that the contents of this consignment am fully and accurately described above by the propershipping name, and are classified, packaged, marked and labeled/placarded, and are in all respects In propermnillion for transport according to applicable International and national governments[ regulations, Ifexport shipment and 1.am the Primary '. Exporter, I certify that the contents ofthis consignment conform to the forms of the attached EPAAcknowledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a) (if I am a large quantity generator) or (b) (if I am a small quantity generator) is Imo. Gega OfferornledRyped Name Signature Month ay Year 2_ 6aACl 6 G� 16, International Shipments t— 11 Import to U.S. . .. ❑ Expodirm U.S. Pod of entry/exit Transporter signature (for exports only): Date leaving U.S.: w17. TranspoderAcknowledgment of Receipt of Materials j Transporter i Pdnted(ryped Name Signature Month Day Year Tmnsporter2 PrintedRyped Name ure - Month Day Year I 18. Discrepancy 18a. Discrepancy Indication Space ElQuantity []Type ❑ Residue ❑ ParBalRejectlon ❑ Full Rejection Manifest Reference Number: 18b. Alternate Fadlky (orGenerator) �. . U,S. EPA ID Number 3 U uL Facility's Phone: nut Inc. Signature ofAkemate Facility (or Generator) Month Day Year Q z 55 19. Hazardous Waste Report Management Method Codes (Le., codes for hazardous waste treatment, disposal, and recycling systems) 2. 3. 4. �Ga 20. Designated Facility Owner or Operator: Codification of receipt of hazardous materials covemd by the manifest except as noted in Item 18a " Printedfryped Name Signature Month Day Year EPA Form 8700-22 (Rev. 3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED)