COMPLIANCE INFO_2019 - Laserfiche WebLink

Home Browse Search

Pledes 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. Pyge1 of 3. Emergency Response Phone 4. Manifest Tracking Number WASTE MANIFEST CAL000405595 015895798 JJ 5. Generalor's Name and Mail! Address Generator's SiteAddress (if different than mailing address) R.4 - AMAPK UNIPIOMN AIN61D CAREER APPAREL LLC 7079 LONGE ST STOCKTON, CA 9520I; Generators Phone:20948`"0105 6. Transporter 1 Company Name U.S. EPA ID Number PHIL€ PVVEST INDUSTRIAL SERVICES CA9000177527 7. Transporter 2 Company Name U.S. EPA ID Number B. Designated Facility Name and Site Address U.S. EPA ID Number CHEMI CAL WASTE MANAGEMENT INC CAT000040117 35251 OLD SKYLINE ROAD KETLE?J! `AN, CA 93229 Facfi lyzs Phone: 1300-222-2904 9a, 9b. 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 Wt.Nol. 1. o NON RCRA HAZ4RDOUS WASTE, SOLID 1 CM V 1491 ! rz 2. S 3. 4. 14. Special Handling Insinuations and AddWonal information PROF] LE 0 CA60E852 j ase � S i c 'f oPa, `h am 15, GENERATOWSfOFFEROR'S CERTIFICATION: I hereby declare that the contents of ibis consignment are fully and accurately described above by the proper shipping correspond 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 certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgmenl of Consent. I cerfily that the waste minimization statement identified to 40 CFR 262.27(a) (if I am a targe quan8tygenerator) or (b) (HI am a small quantity generator) is We. G_ toys/ i's Prin(ed(I'yped Name - Signal - Month Day Year � Vp ✓/ .-r 16. li lemalmnal Shipments F- ❑ import to U.S. ❑ Export from U.S, Port of entrylexit: z Transporter signature (for exports only): Date leaving U.S.: CK 17. TmnspoderAcknowledgment of Receipt of Materials K Transporter 1 Printedfryped Name - Signature Month Day Year N 25 OR/ f� M Transporter ifflintedflyped Name ' ature Month Day Year hf- ' 18. Discrepancy 18a. Discrepancy lndicaflon Space ❑ Quantity El Type ❑ Residuejection El ❑ Padiai Re Rejection Manifest Reference Number: 18b. Alternate Facility (or Generator) U.S. EPA ID Number J U u Facility's Phone: ou 18c. Signature of Alternate Facility (or Generator) F Month Day Year a z N19. Hazardous Waste Report Management Method Codes (I.e., codes for hazardous waste treatment, disposal, and recycling systems) 0 1 . ` ' $ 2. 3. 4. 20. Designated Facility Owner or Operator: Cerfification of receipt of hazardous materials covered by the manifest except as noted In Item 18a Pdnteciffy ed Name Signature Month Day Year e, ' I CC. oq I W EPA Form 0700-22 (Rev. 3-05) Previous editions are obsolete. DES90HATED FACILITY TO DESTINATION STATE (W REQUIRED)