COMPLIANCE INFO_2019 - Laserfiche WebLink

Home Browse Search

designed itch) typewriter.) Form Approved. OMB No. 2060-0039 or type. Form Please print ( 9ned for use on elite 12�p UNIFORM HAZARDOUS 1 . GeneratorlD Number 2, el of 3, Emergency Response Phone 4. Mandest Tracking Number WASTE MANIFEST CALOOCt45595 Pa 4394-24@8 015895867 JJ K 5. Generators Name and Mailing Address " Generator's bite Address gidnerenithan mailing address) ARANAARK UNIFORM AND CA.RLER APPAREL LLC 7679 LONGE ST �TOCKTON, CA 95200 Generators Phone:209434-0105 h; 6. Transpoder 1 Company Name U.S. EPA ID Numb PHiL(P VEST O'NOL1.5TRIAL SERVICES Via 7. Transporter 2 Company NameU.5. EPA ID Number I. B. Designated Facility Name and Site Address , U.S. EPA ID Number CHEMICAL WASTE MAAAGEMENT INC CATL00046117 {:55251 OLD SKYLINE ROAD ; TETFLEMAN, CA 93239 Facili sPhone: 800-222-2964 r t` ga Bb. U.S. DOT Description (including PrepprShipping Name, Hazard Class, 10 Number, 10. Containers 11:Total 12, Unit 13. Waste Codes HM and Packing Group (if any)) d No. . Type quantity wt./Vol. 0 1. NON RCRA HAZARDOUS WASTE, SOLID �s / Ch,A O b 4 _ 491_ � EE z 2. � 9 4. 14. Special Handling InsWctlons end Additional Information ', PRO FIFII LE # CA.I=089/552 Apo ��G plyligw/o °VeA91 (9/" AM , 15, GENERATOR'SIDFFEROWSCERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name, and are classified, packaged, marked and labeledlplacarded, 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 codify that the contents of this consignment conform to the terms of the attached EPAAcknowledgmenl of Consent. . I certify that the waste hembrizallon enil ids-tilijol in 40 CFR 262.27(a) (If I am a large quantity generator) or (b) (ifI am a small quand generator) is true. Genemtotsl amts Pd ped a Signature Month Day Year --r 16. liummational Sh m Ns ❑ Ex ort from U.S. Pod of entry/exit: 11 Import to U.S. Export leaving U.S.: Tmnspoder signature (for expods only): :. W 17. TranspoderAcknowledgment of Receipt of Materials w SiI Month Da Year Transports I Pd tedlfy ed ame g e ®/ !y O ` Signat Month Day Year ZQ Transporter2 nntedlfyp Name Ali r— I 18, Discrepancy 18a. Discrepancy Indication Space ❑ quantity ❑ Type ❑ Residue ❑ Parflal Rejection ❑ Full Rejection Manifest Reference Number: 186, Alternate Facility (or Generator) - U,S. EPA ID Number Zi U r+a- FaciliVs Phone: W 18c. Signature of Alternate Facility (or Generator) Month Day Year Q Z clo19. Hazardous Waste Report Management Method Codes (Io., codes hazardous waste treatment, disposal, and recycling systems) 0 1 . 3. 4. w �}� 3Z 2. - 20. Designated Facility Owner or Operator: Codification of receipt ofUnions materials covered by the manifest except as ndedin Item 18a Printedfryped Name Signature Month Dy Year EPA Form 8700-22 (Rev, 3-M) Previous ditionsare obsolete. DESIGNA FA T® DES y' INATIONSTATE (IF REQUIRED)