COMPLIANCE INFO_2019 - Laserfiche WebLink

Home Browse Search

Please print or type, (Form designed for use on elite (12-pi(ch) typewriter,) Form Approved. OMB No. 2050-0039 UNIFORM HAZARDOUS 1, Generator ID Number 2. Pi e 1 of 3. Emergency Response Phone 4. Manifest Tracking Number pp pp '.. WASTE MANIFEST [:l Lf E7t��Ct5585 i3'd4-331&2408 1015895846 MN/ K ' 5. Generators Name and Mailing Address Generators Site Address (if different than mailing address) '.. ARAM .Rig UNIFORM AND CAREER AP—PAREL LLC: 7 670 LONGE ST QTc CKTOK CA 96200 Generator's Pham,20P 34_0'1 OR 6. Transporter l Company Name U.S. EPA ID Numbs PHILIP V^TEST IINDUSTRIAL SERVICES �J 7. Transporter 2 Company Name U.S. EPA ID Number 8. Designated Facility Name and Site Address U.S. EPA ID Number {.[ {+EClsa"d�iL. sltiA.al-E f�Ed:�.PttACECr1EP�§E i [�4�� i_AT00[C6As3i17 3601 OLD SKYLINE ROAD KETLEMAN, CA 93239 Faciffif es Phone: E**Q 222-20k34 ga 9b. 0.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 Ived 1. i o NO!11RC.'R.A !��,1RDOLISWAS'TE, SOL! Cf i Chi � Y ig 4. I' 14. Special Handling Instructions andAddflional Information PROF! LE 4- CAGOSM2 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurotelydescribed above bythe propershlpping name, and 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 l am the Primary Exporter, I certify that the contents of this consignment conform to the terms of the allached EPAAcknowledgment of Consent. I cedify that the waste minimization statement identified in 40 CFR 262.27(a) (it I am a large quantity generator) or (b) (ifI am a small quantity enerator) is true. GeneratorslOfearr's Pd pedame, Signature MonlDay Year 16. Infema8onal ShipmentiImport to U.S. ❑ Export from U.S. Port of entry/exit: Transporter slgnature (for exports only): Date leaving U.S.: '.. 17. TransporterAcknowledgment of Receipt of Materials '. TranspoM1er1 Printed/Iyped Name ® Signa Month Day Year Ot6v �- / ' a QTransporter 2 Printedffyped Name Signature Month Day Yea ''.. f— yr 18. Discrepancy 18a. Discrepancy Indication Space ❑ Quantity ❑ Type ❑ Residue ❑ Partial Rejection ❑ Full Rejection Manifest Reference Number: 18b. Alternate Facility (or Generator) - U.S. EPA ID Number J U <g Facility's Phone: '.. w 18c, Signature of Alternate Facility (or Generator) Month Day Year a 19. Hazardous Waste Report Management Method Codes (I.e.; codes for hazardous waste treaMent, disposal, and recycling systems) 1. ! 2. 3. 4. 20. Designated Facility Owner or Operator: Certification of receipt of hazardous materials covered by the manifest except as noted in Item 1 JII, ' Prldmirryped Name Signature MI 'dev7 Hear i2 ems : ' (. 6 EPA Form 8700-22 (Rev. 3-05) Pr ious editions are bsolete. DEQ GM&TED FACOL)TY T© DESTp ,AqAT ON STA` E .R, )EQUORED)