COMPLIANCE INFO_2020 - Laserfiche WebLink

Home Browse Search

�1 Please print or type.(Form designed for use on elite(12-pitch)typewriter,) Farm Approved,OMB No.2050-0039 UNIFORM HAZARDOUS ^enerator ID Number 2.Page 1 of 13.Emergencyesponse hone 4.Manifest Tracking Number WASTE MANIFEST l: ��QD� 3�� J�- ��, 01702963)" JJK 5.Generators Name and Mailing Address "Is(if different than mailing address) Generator's Phone: 6,Transporter 1 Company Name U.S.EPA ID Number t,LE.�+I'JTECH EPJ�11RrDNMENTyLlP1C. CgL000368i35 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated F Airy Name nd SiteAddre HEP.ITF,GE-N�11RONMEPJT,AL SERVICES LLL U.S.EPA ID Number 244 EAST STtDRE Y ROAD CCrOLIDGE,:'Z 65128 USA Facility's Phone: 520-7 23-4157 9a, 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit HM and Packing Group(if any)) 13.Waste Codes No, Type Quantity WtNol. X 1. R4,PJf�:3077,HAZARDOUS'%�IASTE,SOLID,n.o.-�.,PG ill,(SRAKE DM P G00? 101 StiA`�9(5JG5,GHRONUUNI),(D007;,EF'G#171 w z 2. LU 3. 4. 14.Special Handling Inslruclions and 981)PROFILE# (� V�// USE GLOVES.AND GOGGLES TRUCK (BRAKE SHAVINGS) (CALLER MUST IDENTIFY CLEAPJTECH Er&IRONfAENTAL.AS REGISTRANT: INFO_TRAC 800-535-505.34 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, 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 allached EPA Acknowledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quanti'y generator)or(b)(fl am a small quantity generator)is true. Generator'slOfferor's Printed/Typed Nam Signature Month Day Year 11 =-J 16,International Shipments r ❑Import to U.S. ❑Export from U.S. Pod Z ntrylexit: Transporter signature(for exports only): Date ing U.S.: 17.Transporter Acknowledgment of Receipt of Materials ' Transporter 1 PrinledlTyped Name Signal a Month Day Year O IL L Q TraU) -- ?C_ 1,k OUOL nspo er 2 PrintedlType ame Signature Month Day Year c r 18.Discrepancy 18a,Discrepancy Indication Space ❑ Quantity ❑T ❑ ype Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number. 181b.Alternate Facility(or Generator) U.S.EPA ID Number U LL Facility's Phone: H18c,Signature of Alternale Facility(or Generator) Month Day Year Q z 55 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 111 G 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 18a Pdnl yped NameSi u l r Month Day Year 42J, IIal3 11-7 1 EPA Foryn 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY'TO DESTINATION STATE(IF REQUIRED)