COMPLIANCE INFO_2020 - Laserfiche WebLink

Home Browse Search

Please print or type.(Form designed for use on elite(12-pitch)typewriter. III�I"aIIIII�IIII�IIIIIIIII�IIII�IIIIIII°�II�IIIIII�UIIII ) Form Approved.OM6 No.2050-0U39 UNIFORM HAZARDOUS 1.Generator 10 Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST cAL00>Zt427E 16 1 8775772E 008548771 F L E 5,Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) Bath R Body Wor-ks#1510 2090 9.339 4950 PACIFIC AVE, WEBERSTOWN MALL/ SPACE 4950 PACIFIC AVE Generators Phone: STOCKTONV CA 95207 STOC 5' 171 6.Transporter 1 Company Name U.S.EPA ID Number Stericvcle Specialty Waste Solutions Inc MNS000110924 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address General Environmental Mgt, LLC U.S.EPA 10 Number 11855 White Rock Road Rancho Cordova, CA 95742 Facility's Phone: 9163510960 CAD980884183 ga_ 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,to Number, 10.Containers 11.Total 12.Unit HM and Packing Group(if any)) No. Type Quantity WtNol. 13,Waste Codes Ir X 1-UN1993, Waste Flammable liquids, n. o. s. (Ethyl 1 CF 00021 P 331 D001 1-1002 o Alcohol, Acetone), 3, PG II, ERG#128 w 2.Non RCRA hazardous waste, liquid (Soaps, 1 DF 00098 P 33 0 Lotions), 3. 4. N 14.Special Handling Instructions and Additional Information 1. 110905(Flammable Liquids) 2. 110902(State Regulated Liquids) 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,and are classified,packaged, marked and labeledlplacarded,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(has 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)(if 1 am a small quantity generator)is true. GeneraorssPredyped,' m _ ignaon aye ar S 061 211201 16.International Shipments Z ❑Import to U.S. ❑Fxpod from U.S. Port of entry exit: Transporter signature for exports only): Date leaving U.S.: w 17.Transporter Acknowledgment of Receipt of Materials Transporter 1 Printedfryped Nameignature Month Day Year Jared Marcie 1 I nspoer2 ntedyped Name I P11 : Q g Month Day Year f- 18.Discrepancy 18a.Discrepancy Indication Space ❑Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number. 18b.Alternate FaaTity(or Generator) U.S.EPA ID Number J U a LL- Facility's Phone: W 182.Signature of Alternate Facility(or Generator) Month Day Year Q � z 19.Hazardous Waste Report Management Method Codes(.e.,codes for hazardous waste treatment,disposal,and recycling systems) 1' ktq( 2 �� 3. 4. 20.Designated Facility Owner or Operator.Certification of receipt haza ous materials covered by the manifest except as noted in It PrinteorIypedName ar / Signature Dayc Ye EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED)