COMPLIANCE INFO_2020 - 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.M613304 ifest Tracking(N'�umJ{berr WASTE MANIFEST Zmz,7 6 l 3 3 V 4 8 3 4 FL E 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) Akin FC W IIC Glockton, CA,95206 Generator's Phone: 7 - 6.Transporter 1 Company Name U.S.EPA ID Number AA c9d O"MIOW-&sn kv.MBA AC:Tran%" CA 701 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address U.S.EPA ID Number VftW N�� CA11 Com(tm CA Facility's Phone: (310)537-7100 ga• 9b.U.S.DOT Descdption(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. 1 Nmi-RCRA Hwwdow Waste tatgtdd p 7.21 z z. w c9 3. 4. 14.Special Handling Instructions and Additional Information ftled I WAW 2ZM DWARMIll DW 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,aryl 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 EPA Acknowledgment 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)(if I am a srgt'quantity generatpryis true. Generator's/Offeror's PrintedfTyped,Name Signature Month Day Year ; tF . `. ; 16.International Shipments 1— ❑Import to U.S. ❑Export from U.S. Port of entry/exit: t ? Transporter signature(for exports only): Date leaving U.S.: W 17.Transporter Acknowledgment of Receipt of Materials I.– Transporter-1 Printed/Typed Name Signature Month Day Year IL N.. 2 Transporter 2 Printed/Typed Name Signature Month Day Year Q -- Ir 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type yp ❑Residue El Partial Rejection ❑Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number J V Facility's Phone: w 18c.Signature of Alternate Facility(or Generator) Month Day Year a Z F) 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/Typed Name Signature Month Day Year EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. GENERATOR'S INITIAL COPY