Laserfiche WebLink
Please print or type. (Farm designed for use on elite (12-pitch) typewriter.) Form Approved. OMB No. 2050-0039 <br /> UNIFORM HAZARDOUS L Generator ID Number 2. Page 1 of 3, Emergency Response Phone 4. ManifesfTracking Number <br /> WASTE MANIFEST Cf .l�1©� �'�9� [ "-�'� 015895880 3J <br /> S. Generators Name and MailingAddmss Generators Site Address (if different than mailing address) <br /> RAIUARK UNIFORM MAD CAREER APPAREL LLC <br /> 7 079 LONGE ST <br /> STOCKTON, CA 95200 <br /> Generators Phone:209434-0105 - <br /> 6, Transporter 1GompanyName 0.5. EPAID Number 261S <br /> PHILIP WEST INDUSTRIAL SERVICES CAR000 52 <br /> 7. Transpoder2 Company Name - U.S. EPAID Number <br /> 8. Designated Faclllfy Name and Site Address U.S. EPA ID Number <br /> CHEMIC,s WASTE MANAGEMENT INC CAT000546117 <br /> 35251 OLD SKYL I NE ROAD <br /> KETTLEMAN, CA 03239 <br /> Parma es Phone: 800-222-2964 <br /> go, 9b. U.S. DOT Description (Including Proper Shipping Name, Hazard Class, ID Number, 10. Containers 11. Total 12. Unit 13, Waste Codes <br /> HM and Packing Group (if any)) No. Type Quantify Wtivol. <br /> 1. ppp <br /> � NON RCRA HAZARDOUS t+VASTE, SOLID 1 Cm � � t �'9� <br /> � <br /> O ^I <br /> v <br /> 4. <br /> t <br /> 14. Speclai Handling Instructions and Additional Information Ilff. <br /> PROR LE # CA008852 <br /> fiC ' OC CC 9 P ® 'SPS% 7golZ. <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name, and are classified, packaged, <br /> marked and labeledlplacarded, and am in all respects in proper condition for transport according to applicado International and national governmental regulations. If export shipment and I am the Primary <br /> Exporter, I cedlly that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. <br /> I codify that the waste minimization statement Identified in 40 CFR 262.27(a) (if I am a large quantity generator) or (b) ( fI am a small quantity generator) Is true. <br /> GmwralorslOQewreP tedliype / - Signature d� Month Day Year <br /> c �6 <br /> J 16. Infernallonal Shipments �1 <br /> j_ ❑ Import to U.S. tJ Export from U.S. Pad of enfrylexit: <br /> Transporter signature (for exports only): Date leaving U.S.: <br /> out 17. Transporter Acknowledgment of Receipt of Materials <br /> K Transporter 1 Printedliyped Name Signature Month Day Year <br /> a If <br /> k 'fp <br /> rnMonth Oa Year <br /> 3 Transpo r2 r ed yp dName Signature y <br /> a <br /> q. 18. Discrepancy <br /> Ise. Discrepancy Indication Space ❑ 'Quantity ❑ Type ❑ Residue ❑ Partial Rejection ❑ Full Rejection <br /> Manifest Reference Number. <br /> 186. Alternate Facility (or Generator) U.S. EPA ID Number '.. <br /> J <br /> U ' <br /> uE <br /> < Facility's Phone: '.. <br /> w 18c. Signature of Alternate Facility (or Ga ender) Month Day Year <br /> a <br /> Z <br /> 19. Hazardous Waste Report Management Method Codes (Le., codes for hazardous waste treatment, disposal, and recycling systems) <br /> 3. 4. <br /> 20. Designated Facility Owner or Operator: Cediticatlm of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> PdI dllyped Name Signature Month Day Year <br /> W <br /> r 63 121 1 <br /> EPAForm.8700-22 (Rev. M5) Previous editions are obsolete. ®ESEGNATeE3 FAOEEETVTO DIESTINATE0M sum (or REaumcf) <br />