|
06 / 11 / 2021 1 : 40 Phi FAX 2099488625 AMCE SAW 0007 / 0008
<br /> Please print or type., oil Form Approved. QMB No. 2050-4039
<br /> UNIFORM HAZARDOUS 1 : ¢eneralor I!7 Number 2. Page i of 3, Emergency Response, Phone 4, M IftGk g o /} p
<br /> WASTE MANIFEST 178438 ".X 6 a e �'7 PG
<br /> S, enerator's Name and Meiling Addrasa • • • • . Oeneretors Site Address (If dJffaront than mailing addrass)t
<br /> ActAir sew
<br /> 12d4 , 5T
<br /> I to
<br /> Generators Paan ' w $TOCKTON , CA S#S 5
<br /> 6, Transporter 1 t a . ; °t :. U,$..EP •ID Number It
<br /> . i' is ':, i :.J
<br /> .11 'i r' fP.i.vr,..:k.. '.w�lfll) ,:{L�r +.✓1,1� t000000� ' ..• /• � . I •f
<br /> INA �r9Ol ' :: .' : .' ' ' ; It af' °' u:; . : �'. q.., ,
<br /> ?... 1 llie loo , �'iM'-•.='7` ",,.a uw:.•"'u-.: +=.�ti.._'Iht,:,:.w;r..::i.;i+'•%'e '°wY .• _ _ '" .
<br /> . , �. I• i
<br /> DwInctlimpt" to
<br /> 8, Designated Facility Name and Site Address I 1 4 4 4 U,& EPA ID Number '
<br /> 'ttJ11I YES 2 W TRANSFER FACIL11TY AZROWS21146
<br /> 6514; ;16 HI'ti* W AY 85
<br /> YUM A, AZ 853>�,.ir'
<br /> FedlVs Phon
<br /> ga, gb. U.S. DOT Description (Indudk{g ProperShipping Name, Hazard Class, ID Number, f 0. contetrlara i1 , Total 12. Unit
<br /> ' 13. waste Codes
<br /> HM And PAd(1h0 Getup (if anY)) ' No. Type Quantity Wt,Nol,
<br /> 1 ,
<br /> ot it
<br /> to ' 0 ' � 0r+, RCRA .Fffi .�1f�b�ll1S •ilVtit. a SOLIC1, A4
<br /> ' tlaFtg�T+i•fS, L �
<br /> 6I ' I UAt1 P
<br /> 352
<br /> S' lot DEORISI
<br /> z 2, 1 1 4 1
<br /> ,
<br /> lopppPolp IMF
<br /> 3.
<br /> .. /
<br /> 1 919311111
<br /> ::,,
<br /> ;, ;,; ;;
<br /> . . . '
<br /> 111
<br /> .. :, ....a,v *.w..,., „•,m,..eN .. ....,...........�.x�.o:,.. :...e_:,:,:.., ,,.:r, l,: ,.., .�,.�o :;-,_, : ,,: xl :;a�• ,';. w,,. ;.,,..� ':,r: ' ,.:.%> 'w •, .!!.hr, ,.. „'+H `thee ,^:':_
<br /> . ,.
<br /> .
<br /> I'll:1
<br /> 14, Special Handling Insbuctione'andAdd t(Qnai Information
<br /> toll
<br /> PRONLENAt35>71;tS1=AtT, OIL ERGO Ill
<br /> to
<br /> F1viE4CtY C+DI>�IAt; f : 10i1 tJiJ Trr1do
<br /> ��� .
<br /> 1s. ' QENERATOR'$IOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment aye fully and accurately described above by the proper shipping name;and are dasOod, packaged, it I
<br /> marked end labeled/placarded, and ale in all respect$ tri proper condition fortran8port according to applicable international and national governmental regulations, If expert, shipment and I am the Primary
<br /> Exporter, I cenlfy that the contemn of this.consignment conform to the tens of the attached EPA Acknowledgment of Consent 11 . ,
<br /> I certify Ural the waste minimization statement identified in 46 CFR 262,27(s) (if I am a large quantity generator) or dI am a small antily generaEer) is true.
<br /> Genaratoesol fetor's PfiMp Jiltyyped Narho Sit nature( a+-, Month Day ; . Year . : .
<br /> 1 1t I 4 t ' .:
<br /> AIN 02
<br /> 1B. IntemationalShlpme
<br /> nn
<br /> Y" Imporl to U.S. .J Export Bora U,S, Port of anbylexit: „
<br /> Transporter signature (for exports only): Date leaving U,S.;
<br /> 19 17. TransportorAcknmAedgmentof Receipt of Moterials Ate
<br /> Transporier,l Pri Natr Signature ' ' o Mr pay Year
<br /> O ^�
<br /> � or 4 OML .
<br /> Trans r 2OP6 . N 5 m trtgnptut
<br /> nth ' `Day " Year'
<br /> F ,.
<br /> •::sr . :� = r " '' : • • :., ' ::^'•. ::. ;,./ r. , r ,,,�:'• . ;' '� ,. . ;'fu „ .aef6;'rt.•' • :` ilr' .?F%?�:,' :,:• • " t ' . '.6 :.K ' t %u . '.uGdY�: •,ts�ahc't•Fq't'- t'��'.'�% .y;��f•AA�
<br /> .w
<br /> � • .i' .P•^ �:y'� �r Y�:rSiKlli�L..�•. (.l'1•' ,.:Y:iC!F+.�. ) ,r �.. 'S'i�"•5'.,i.na�i ,i r
<br /> itis. DisofepancylndlCatldn'S acc' ` , , :r. ' , :It _ . ,, ,,,: • ` ' . to
<br /> .
<br /> ., ..:., .nn. . . t e::;,.,.,.:. r' ,.�_-.�_}.., .v jjam� ,
<br /> p I,,,J Qusndty 'Type ' r` 4 Re's c lJ paMtal Rejection cult R9jection'••?
<br /> i8b. AltamataFaall (or ManifestReferenteNumber,
<br /> Facility ( } U,S. EPA ID Number
<br /> LL Facfrrly's Phona:
<br /> Uj olk Stgnaturo of Altemata Factiity (or Generator) Month . Day Year
<br /> —y 19, Hazardous Waste Report Management Method Code$ ( s., codes far hazardous waste treatment, disposal, arta recycling systems)
<br /> 1. � C' 11 I
<br /> 20. Designated Facility Oumar or Operator Certification of receipt of hazardous materials covered by rho manifest except ag noted in I 18a ,
<br /> Prin edfTyped Name nature Month ay ear
<br /> I 1 2W loot ento, 1r
<br /> , EPA Form 870042 (Rev. 1247) Previous editions are obsolete. ( Q 0EVONATED• FACILITYTO GENERATOR
<br /> j
<br /> l
<br />'r
<br /> i
<br /> i
<br />
|