Laserfiche WebLink
Please pflnt ortype. Form Approved.01VIB No.2050-N39 <br /> .pilaa 1 m <br /> il <br /> u's nr 5.nw.�qtny Responso Phone 4.-Up,�st Trackitna Member <br /> HAZARDO <br /> WASTE MANIFEST =r A D 8 2 b 6, 4:1 :1 4,24-9,; l0 0 2 0 3 JA <br /> 5:Ger-eralcet Name and Willing Address G,wilorE.81a Address(if different than mailing address) <br /> &WIM ORME WORKS <br /> 2373 E,14 MP40SA RD <br /> QTMKTON CA 95205 E 11AA-1111-UlA R%D <br /> Generator's P.howsm C K,011 CA 9520-5 <br /> U.S,EPA ID Number, <br /> WORLD OIL ENVIMON N49 KAL SCRY'G E—R ie,A.D1Y2-.$'2 I TO 3 6 <br /> 7.T fansWlc r 2 Company Name U.S;EPA ID Numbe., <br /> 8.Dwnawd Facilfy Name sad Sile Address U.S,;EPA 0 NmW <br /> US ECOLOGY VERNON IRR <br /> 5375 SOUTH BOYLE AVENUE <br /> LOG ANGELES CA 90,058 <br /> FacKlYaPhone: <br /> : <br /> 9b.U.S '0ro6r pe N <br /> pipping ame,IFIazardd*-P. r,' 10 Conomts <br /> Ii.Tdal 12,Urii: <br /> HIM and Packing Group(t any)) Waste Codes <br /> No. Type 0�011tilly VkNol. <br /> C <br /> j <br /> U 2.Rq UN25§$', WW�:C0pRLSwJjQ0ID;7N: <br /> ACIDS).8,Mill W2 ?$I <br /> w -'7 <br /> S. 4,, <br /> T Spechill Handling knstr&lors and Addidonal Iniamallon <br /> EMERGENCY CONTACT:CHEMTREC 1-8MQ4-93W WM TERMINAL.,GERES.CC5 <br /> � <br /> 951 1 6METAL 27253 SHAVINGSYDUST,982.62qW2 ALKYLSULPHOWC ACIDS,CL EANIM SOLVENT FOR SIM <br /> P-W4010OW6B*APPROPRIATE PP14 <br /> E EQUIPMENT :L <br /> 15. GENERATOKS16IFFEROR'S CERTTFICATION:I kreby declare that the contents of this consignmenfalie fully and a,cGuratelydascribed above by flie propershipping naTlovwif are cl=044 paduiged, <br /> marked and tabefcdlpl3rapied,and are In all rcspecls in propucondilion for transport according to applicable internationaland national oovornniarTW regulations,9 eNPW shipment ad I am the F'rlmary <br /> Exporter,I certify ftt the contents of this tonsignmentoonform to the terms of the attached EFAAcknowledgmen!of Consent. <br /> I certify that the wgsternlnimbston statement identified in 40 CFR 262,27(a)(ff I am a large.quantity generator)or(b).(if I-am a small quantily genaraWF)is true. <br /> P4n1e&T]ypqd Name Gen la�h'-Ffles Sign8lQre' Month bq Year <br /> 16.inlernallonalShipmentsr L1 Import to U.S. 11Ex*ftrn1J.5. Port of entry/exi.t. <br /> Transporter signature(for exports only): Date leaving LS.: <br /> W 17.7r3n*er AOmwLedgMent of Receipt of.Materials <br /> TraMpo I PrinledITTO NSignature r Month Day Yinar <br /> Transporter 2 Printed/Typed Vrne Signature Month Day Year <br /> 18.Discrepancy <br /> 1 Ba.Discrepancy Indication Space. El Quantity D Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Number- <br /> t. 18b.Alternate Facaity(or Generator), U S.EPA ID Number <br /> _J <br /> U <br /> Facility's Pbone: <br /> LLI 16e.Sign-alure of AllumRk F8dilly(qr Generator) Month Day Year <br /> 0 <br /> za 19.Hazardous Waste Rtlport MBrogenrW Method Codes(ie,,codes for hazardous waste treatment,disposal,and rMc"syslums) <br /> UJ 1 2. 3. <br /> 20.Designated Facility Oymer or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> PrWed7yped Name Signature Month Day Year <br /> 6,fl 6 <br /> EPA Form 8700-22(Rev.12-17) Previous edifions are obsolete. TRANSPORTER COPY <br />