Laserfiche WebLink
Please print or type. Form Approved. OMB No. 2050-0039 <br /> UNIFORM HAZARDOUS 1. Generetor ID Number 2. Page 1 of 3. Emergency Response Phone d. Man'rfest Tracking Number <br /> WASTE MANIFEST CAL000286489 I 1 -BFftCMJ225 4 ELE <br /> U1c _ � � <br /> 5. Generator's Name and Mailing Atltlress Generator's SileAtltlress ('rfdifferentthan mailing address) <br /> Dra ESP LTD <br /> 15700 MoKinlee�� �A�tue sherri. helfiea®nwclernusa. corn <br /> Lathrop, CA 9533D <br /> Generators. Phone: 209468-9125 <br /> 6. Transporter,1 Com any Name U.S. EPA ID Number <br /> Achanced Nerricaf Transport InC1DBA ACTENVIRO CAR06O070540 <br /> 7, Tyrensporter 2 Company Name <br /> �- ,nvpr,yi System, In U.S. EPA ID Number <br /> CAR000175422 <br /> B. Designaied Facility Name and Site Address <br /> - - U.S. EPA 10 Number <br /> 1:3ii k.uma, AZ 85385 A1I,St Zc0o0575s24 <br /> Y <br /> Facility's Phone: 92$344-9828 <br /> ga, 91c. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Containers <br /> HM and Packing Group (if any)) 11 . Total 12. Unit 13. Waste Codes <br /> No. Type Quantity WL/Vol. <br /> 1.. on-M(. ! aZaLdous asie Liquid (Oil, later) <br /> o TP P d <br /> W 2. <br /> /t <br /> 3. <br /> I <br /> I <br /> 4. <br /> 14. Special Handling instructions and Additional Information / 5 201 Doclxncivil # L�3'1 <br /> 11 1811707 DR.Y. � J t 3 Y 7 <br /> ( n� t � � CTS „ <br /> FIntematlonal <br /> RATOR'S/OFFEROR'S CERTIFICATION; Thereby declare that the contents of this consignmentare fully and accurately described above by the proper shipping name, and are classified, packaged, <br /> d and labeled/placarded, and are in all respects in proper condition for hansport according to applicable intemationaland national governmental regulations. If export sh'ryment and I am the Primary <br /> er, I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. <br /> that the waste minimization statement identfied in 40 CFR 262.27(a) (if I am a large quantity generator) or (b) (ifI am a small quantity generator) is true. <br /> Offerors PhntedRyped Name Signature Month Day Year <br /> nal Shipments r jImport to U.S. ❑ Export from:U.S. Port of emrylexitsignature (for exports only): <br /> Date leaving U.S.: <br /> did <br /> 17. TansporterAcknowledgment of Receipt of Materials <br /> 1— Transporter 1 Pdnted/Typed Name Signature <br /> O� - - -.-- Month Day Year�j <br /> z Transporter2Printed/typed Name <br /> Qct re i Month Day Year <br /> 18. Discrepancy <br /> 18a. Discrepancy Indication Space ❑ Quantity ❑ T e <br /> YP ❑ Resitlue ❑ Partial Rejection ❑ Full Rejection <br /> > Mani Reference Number: <br /> F 18b. Alternate Facility (or Generator) <br /> U.S. EPA ID Number <br /> V <br /> nai Facility's Phone: <br /> 18c. Signature ofNtemate Facility (or Geneator) <br /> Month Day Year <br /> N19. Hazardous Waste Report Management Method Codes (i.e, codes for hazardous waste treatment, disposal, and recycling systems) <br /> M 1 . 2' J. <br /> 4. <br /> 20. ignated Facility.Owner or Operator Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Pdnt yped Name Signature <br /> Month Day Year <br /> EPA Form 8700-22 (Rev. 12-17) Previous editions are obsolete. <br /> GENERATOR'S INITIAL COPY <br />