Laserfiche WebLink
:. w <br /> ,ned for use tin elite(12-pitch)typewriter.) Form Approved.OMB No:2050 0039 <br /> ��US 1{Generator ID Number 2.Page 1 of 3. me R s e P 4.Manifest Trackin Number. <br /> x. 75 Zg �'y <br /> A'EST <br /> LE <br /> s ame and Mailing Address Generator's Site Address(d different th6h niaiiing address) <br /> SA aldip" Gat E. ES <br /> >iS t' West Stanford Rd Attn 94iauel Mchenry 18,501 Stanford Rd <br /> TRACY CA 95377 Attn Losttf- Saba <br /> Generator's Phone' 2 �14-5374 TRACY 93377-9708 <br /> SYSTEMS INC U.S.EPA ID Number 1 k 1 <br /> 7. <br /> Transporter 2 Company Name U.S.EPA ID Number <br /> 8:Designated Facility Name and Site Address' Y" �^ NIAU S:EPA ID NOF umber {, <br /> 6880 SMITH AVE. <br /> ARK t= 94560 <br /> 9, 10-795-4400 CAD911019674113 <br /> 674113 <br /> Facility's'Phone: <br /> ga, 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit <br /> HM and Packing Group(if any)) No. Type Quantity Wt.Nol. 13.Weste Codes <br /> l-'.NrJN-RCRA HAZARDOUS WASTE9 LIQUID TT <br /> W 2. <br /> 3:. <br /> 4. <br /> 14.Spectai Handling Instructions and Additional Information -- m _ <br /> - -- <br /> . - - CSC <br /> 4 HR EMERGENCY 01-0.00-468-1760 (CH J SK e TFI) <br /> At 1 A ` "ASEN -FOR" BY BEN TO RETAIN LICENSED go CARRIERS AS NECESSARY <br /> 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, <br /> 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 I am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowtedgment of Co ent. <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b 1 am a skit quantip generator)is true. <br /> Generators 0 erors Printed/Typed Name i Month Day ear <br /> 16,International Shipments 47 <br /> Z ❑Import to U.S—. ❑Export f8ro U.S. Port of entry/exit: <br /> Transporter signature for exports only): Date leaving U.S.: <br /> W 17. ransporterAcknowledgment of Receipt of Materials <br /> Trans er 1 Printed/Typed Nage// r i ture Monthay Year <br /> z Transporter_Pnntedfryped Name = <br /> Signature Monm Day Year <br /> F- <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ yp ❑type 4 <br /> ❑ Quantity Residue ❑Partial Rejection ❑Full Rejection-,, <br /> Manifest Reference Number: -, <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number ; <br /> c� <br /> a <br /> L- Facility's Phone: <br /> W 180.Signature of Alternate,Facility(or`Generatgr) Month Day Year <br /> a <br /> Z <br /> 19.Hazardous Waste Report Management Method Codes lie.;odes for hazardous waste treatment,disposal,and recycling systems) <br /> W 1• ! 2. <br /> 0 <br /> 20.Designated Facility`Owner or Operator;C rtifiration of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Print d/Typed Name { Month Day Year <br /> v y; f Signature <br /> , - <br /> _. ' . <br /> EPA Form 800-22 ev..3.05) Previous editions are obsolete. t/ DESIGNATED FACILITY TO GENERATOR <br />