COMPLIANCE INFO_2019 - Laserfiche WebLink

Home Browse Search

Please print or type. 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 CG 4Z :2 1 . 916.371-5747 0 2 0 3 9 0 5 5 0 JJ K 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) Arrlr' .piling s:'.1's�4 ► lay f-P$?Z-0K[ ' -S Ave-. Generator's Phone• yn Micro 6.Transporter 1 Company Name U.S.EPA ID Number RAMOS WORONIVIENTAL SER ICES INC. CADO440 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address PACIFIC RESOURCE RECOVERY U.S.EPA ID Number 31`70 EAST PICA BLVD. GADCr'0@'2S2405 LOS ANGELES,CA 901023 Facility's Phone:WO-4W7145 9a. 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. z 2. w f 3. 4. 14.Special Handling instructions and Additional Information �, .-. 901) ERGO 47 � y J,.'6 G- HAMOLERS TO BE TRAINED AND USE APPROVED PPE. E.R. COlk"ACTOR; RAMOS ERIVIRONkiENTAL SERVICES 15. GENERATOR'S/OFFEROR'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 EPAAcknowledgment 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)(ifI am a small quantity generator)is true. Generator's/Offerors Printedffyped Name Signature Month Day Year 16.International Shipments F-- ❑Import to U.S. ❑Export from U.S. /Port of entry/exit: Z Transporter signature(for exports only): Date leaving U.S.: W 17.TransporterAcknowledgment of Receipt of MaterialsLLI ?"1 Transporter 1 Printed/Typed Name j Signature Month Day Year Oa QTransporter 2 Printed/Typed Name.. Signature - Month Day Year 7- 18.Discrepancy 18a.Discrepancy Indication Space ❑ quantity ❑TypeEl j j Residue Partial Rejection Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number J_ V LL Facility's Phone: QW 18c.Signature of Alternate Facility(or Generator) Month Day Year Z 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 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 Printed(fypad Name Signature Month Day Year EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. GENERATOR'S INITIAL COPY