FIELD DOCUMENTS - Laserfiche WebLink

Home Browse Search

Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST C A L 0 0 0 0 9 5 9 9 6 1 (800)424-9300 015481676 J J K 5 G r tor's a an Mailing Address Generator's Site Address(if different than mailing address) 'l° �er Street,Manteca,CA 95337 9NOOLARRdini Drive,Manteca,CA 95337 (209)456-8415 Attn: Greg Showerman Generators Phone: 6.Transporter 1 Company Name U.S.EPA ID Number 7.Transporter 2 Company Name U.S.EPA ID Number 8. a ddress U.S.EPA ID Number 2500 West Lokern Road,Buttonwillow,CA 93206 (661)762-6200 C A D 9 8 0 6 7 5 2 7 6 Facility's Phone: ga 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.Nol. 1. 6 1 1 D008 0 0 NA3077,Hazardous Waste, Solid,N.O.S.,(Lead),9,PG III 00 1 D T 18 Y M 2. UJ c� 3. 4. 14.Special Handling Instructions and Additional Information Soil: 95-100% Clean Harbors Profile Number: C H 1 3 1 2 3 12 B Vegetation 0 -5% Wear appropriate Personal Protective Equipment as necessary 15. GEN ERATOR'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, 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 I am the Primary Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a small quantity enerator)is true. GeneratotslOfferor's Printed/Typed Name Signature Month Day Year (on behalf of the City of Manteca) � 2 � --J 16.International Shipments Elle of Import to U.S. Export from U.S. Port le nU.S.:t: Transporter signature(for exports only): Date ing U. 17.Transporter Acknowledgment of Receipt of Materials Transporter 1 Printed/Typed Name Signature Month Day Year o13 11311.,2- N Z Transporter 2 PrintedlTyped Name Signature Month Day Year Q t- 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: H 18b.Alternate Facility(or Generator) U.S.EPA ID Number J U 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) 0 1 �A1n ^ 2. 3. 4. 20.Designated JFFacilityyOOwner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Printed/Typed Name � � �� Signature Month Day Year 07 I EPA Form 8700-22(Rev. -05) Previous editions are obsolete. DESIGNATED FA ILITY T D STINATION STATE (IF REQUIRED)