COMPLIANCE INFO_2019 - Laserfiche WebLink

Home Browse Search

Please print or type. (Farm designed for use on elite (12-pitch) typewriter) Form Approved. OMB No. 2050-0039 UNIFORM HAZARDOUS 1 1. Generator In Number 2. Page of3. Emergency Response Phone 4. Manlfest7racking Number WASTE MANIFEST CAL03040595 E44-3�t4-24i0 015895JJ 5. Generator's Name and Mailing Address Generators Site Address (if different than mailing address) APAIWARK UNtF%}MM AND G.dtREEP i3PP ARE LLC 7073 LONGE ST STOCKTON, CA 90200 Generator's Phone:209`294-13105 e. Transporter t Company Name U.S. EPA ID Numbs PHILIP VVE'ST INDUSTRIAL SERVICES 40ArQWAQ -1 7 ,? 7. Transporter2 Company Name U.S. EPA ID Number B. Designated Facility Name and Site Address U.S. EPA ID Number r"F#E��I CAL 'cft�AST S Pa'd>'APv'�is EI;nEN7 INC C:rATf0I�64Ei1 'd 7 35251 OLD SKYLINE ROAD KETTLEfolATN, CA 93239 Facilitys Phone: 80M2M002 is. 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.fool. . 0 NON RCRJ R�DOUS WASTE, SOLID 1 Chi � � V d21_.I4 Z. all 3. t E If k 4. t 14. Special Handling Instructions and Additional Information PROF=ILE 4 CA13013852 AWA IZQL6 15. GENERATOR'SfOFFEROWS CERTIFICATION: i hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name, a are classified, packaged, marked and labeledlplacarded, and are in all respects in proper condltion for transport according to applicable international and national governmental regulations, if expert shipmentand I am the Primary Exporter, I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgmont of Consent. I codifyihat the waste minimization statement identified In 40 CFR 262.27(a) (if l am a large quantity generator) or (b) (if l am a small quantity generator) is We. Generators/OOfffecors PdntedlT a Signature , Month Day Year �- YP ) ', � ,/ � -- 916 igffuz J 16. International hipments f i— ❑ brand t U.S. El Export from U.S. Pod of entry/loft: Transporter signature (for experts only): Date leaving U.S.: w 17. TransporterAcknowledgmentof Receipt of Materials - Tramps Printed/f, ped Name � Signator Mo th Day Year 0 . a I It ow QTransporter 2wrintealTyped N e Signature Month Day Year K h 18. Discrepancy 18a. Discrepancy Indication Space ❑ Quantity El Type ❑ Residue ❑ Partial Rejection ❑ Full Rejection Manifest Reference Number: 181h. Alternate Facility (or Generator) - U.S. EPA ID Number J U ua- Facility's Phone: w 18c. Signature of Alternate Facility (or Generator) - Month Day Year Q Z 19, Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) GO 4, 20. Designated Facility Owner or Operator: Certification ofmcelpt of hazardous materials covered by the manifest except as noted in Item 18a Printed/Typed Name Signature Month Day Year EPA Form 8700-22 (Rev. 3-05) Prevloob editions are obsolete. DESIGNATED EAd rFP - OfD'EST106iATIOMSTiAE (IFREQUIRED)