Laserfiche WebLink
C� <br /> Please print or type.- , yeFarm Approved. OMB No. 2050-0039 <br /> UNIFORM HAZARDOUS-' b Generator ID Number 2'. Page 1 of 3. Emergency Response Phone 4. Manifest Tacking Number <br /> WASTE MANIFEST CAL00028Br 1 888-78&7215 012283676 FLE <br /> 5, Generators Name and Mailing Address. Generators Site Address (if different than mailing address) <br /> Dragon ESP LTD <br /> 15700 McKinl Avenue shell hedhea@modernlcom <br /> Lathrop, CA ! <br /> Generators Phone: 2094358-9125 <br /> 6. Transporter 1 Com any Name U.S. EPA ID Number <br /> Advanced Com <br /> Transport inC./DBA ACTENtill CAR00007OW <br /> 7. Transporter 2 Company Name U.S. EPA ID Number <br /> B. Designated Facility Name and Site Address U.S. EPA ID Number <br /> US Ecology Nevada Inc <br /> pP�O,,�EICK Mit 9 , 11 MileS S Beatty NVT330010000 <br /> MW <br /> Facility's Phone: 775-5322M <br /> ga, 91p. U.S. DOT Description (including Proper Shipping Name, Hazard Class, 10 Number, 10. Carl ners11 . Total 12. Unit <br /> HM and Packing Group (if any)) 13. Waste Codes <br /> No. Type Quantity Wtivol. <br /> Hazardous waste, solid, n o.s, (Chromium), W P 181 D007 <br /> � x <br /> R <br /> I W <br /> Zx 2 NAS Hazardous Waste s cerium , DM p D005 181 <br /> X 3. soll rill 0007 0011 181 <br /> SILVER), 9 , PGID DM ( � p <br /> 4. l•� <br /> 14. Special Handling Instructions and Additional Information P 0 183120 Docurnilinit # 19tR <br /> 1 ) ERCIll 070128303.13302 DRIIl 5;eur ) EFJM71: 07012.8303.6900 DRtI /Y 3'Sor> <br /> 2) 07012830145179 0811 :5. <br /> (3X j Soi <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby deda7that�the contents of this consignment am fully and accurately described above by the proper shipping name, and are classified, packaged, <br /> marked and labeled/placarded, and are in all respects in proper condition for transport according to applicable internafional and national governmental regulations. If export shipment and I am the Primary <br /> Exporter, I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a) (if I am a large quantity generator) or (b) (ifI am a small quantity generator) is true. <br /> GeneratoeslOfferor's Pnnted/7yped Name - Signature Month Day Year <br /> 16. International Shipments <br /> r— ❑ Import to U.S. ❑ Export from U.S. Port of entrylexit <br /> ? Transporter signature (for exports only): Date having U.S.: <br /> oc 17. Transporter Acknowledgment of Receipt of Materials <br /> Tansporteri Pnnted/Typed Name Signature � � . Month Day Year <br /> aEll <br /> ans er note yped Name gnalure Doth Day ear <br /> H <br /> } 18. Discrepancy <br /> 18a. Discrepancy Indication Space ❑ Quantity ❑ Type ❑ Residue ❑ Partial Rejection ❑ Full Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility (or Generator) U.S. EPA ID Number <br /> I J <br /> U <br /> LL Facility's. Phone: <br /> w 18c. Signature of Alternate Facility Generator) Month Day Year <br /> a <br /> Z <br /> W19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal,and recycling systems) <br /> Lou 1 1 <br /> 1 <br /> 1 ') a 1 ) a 3 4.20. Designated Facility Owner or Operator:Certfication of receipt of hazardous materials covered by the manifest except as in Item 18a , <br /> Pri edlTyped Nae Signature Z .Z Month Oa1 Yeear" <br /> J 1 X06 <br /> EPA Fo 7 e . 12-17 Previous editions are obsolete. DESIGNATED FACILITYTO GENERATOR <br />