Laserfiche WebLink
Please print or type. <br />TUNIFORM HAZARDOUS <br />WASTE MANIFEST <br />0 <br />w <br />Z <br />LU <br />a <br />5. <br />Generator ID Number <br />Quik Stop Markets, InC- <br />165 Flanders Road <br />G9estorough, MA 01581 <br />onern s one: <br />Transporter i Company Nemo <br />7 Transporter <br />2. Page 1 of 3. Emergency Response Phone <br />I (800) 424-9300 <br />U S. );col qy Nayy da Operations <br />lighway 95, it tniles S. of Beatty <br />gtastPO, NV 89003 (775) 553-2.203 <br />ga 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, <br />HM and Packing Group (if any)) <br />Non-RCRA Razardous Waste, Solid (ERG #171) <br />(Rags, absorbent, S debris impacted With <br />petroleum hydrocarbons) <br />3. <br />Form Approved, OMB No. 2050-0039 <br />4. <br />Generators Silo Address (If dlloront than mailing address) <br />Quik Sto Marketa, Inc. #124 <br />505 N. Main St. <br />Manteca, CA 95336 <br />U.S. EPA ID Number <br />NVT330010000 <br />10. Containers 11. Total 12. Unit <br />No. Type Quantity Wt.Nol. 13. Waste Codes <br />i P 352 1*D0181 <br />{ I0 <br />I <br />4 Special Handling Instructions and Additional Informnllon 0 LABQ AT DOTTED <br />WEAR ALL APPROPRIATE BEST <br />Generator is a RCRA VSQG as det'ined in PERSONAL PROTECTIVE 323719 E Of HTO RI S <br />40 CFR 260.10. 0018 code represents CLOTHING, QUIKSTOP CCN: 659237 ; SIDE OF LSSOOOS, <br />TAB 9ltL dlli5 30 iTu�t <br />waste that is RCRA identified but not � X55 � T�asTtcr<saur <br />PROFILE # 070214257-0 <br />15. GENERATOR'SIOFFEROR'SCERTIFICATION: (hereby cedars that the contents of this consignment are fully and accurately <br />RCRA r��ldt�+d.- - — -- ; <br />described above by the proper shipping name, and are dassifi <br />marked and labeledlplacarded, and are in all respects In proper cendition for transport according to appilceble inlemationaland nal'ronal governmental regulations, II export shipment and i am the Primary <br />Exporter, I certify that the contents of this consignment conform to the terms of Uce attached EPA Acknowieugment of Consent. <br />I certify that the waste minimization statement identified in 40 CFR 262.27(a) (if I am a large quantity genamlor) or (b) (if[ am a small quantity gonerator) is true. <br />RM r0:9 <br />❑ Import to U.S. <br />17. Tmnspater Aclkmndedgment of Receipt of Materials <br />❑Export from U.S. <br />16. Discrepancy <br />itis. Disaepancy Indicetion Space ❑ QuanBty ❑Type <br />18b. Allemato Facility (or Generator) <br />J <br />U <br />LL Facility's Phone: <br />w 18c. Signature of Alternate Facility (or Generator) <br />Q <br />z <br />N19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, <br />G 1' %_k .tib 12 <br />20. Deskdn, ,ed acilii <br />Printedffyped Alamo <br />EPA Form 8700-22 (Re <br />124/2420107' <br />Port ofentry/axil: <br />Date leaving U.S.: <br />❑ Residue <br />and recyding systems) <br />Owner or Ooeretor: Certification of receiot of hazardous materials covered by them <br />Previous editions <br />as rk�ed in Item 18a <br />❑Partial Rejection <br />1g�2 <br />❑Full Rejection <br />ESIGNATED FACILITY TO EPA's e -MANIFEST SYSTEM <br />