Laserfiche WebLink
RECEIVED BY SJCEHD (EF) ON 5/15/19 <br /> Form Approved.OMB No.2050-0039 <br /> Please print or type. 4.Manifest Tracking Number <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2,Page 1 of 3.Emergency Response Phone <br /> WASTE MANIFEST CAL000411324 1 408-363-3618 019 5 9 4 6 0 4 JJ K <br /> 5. ne tors Nage and FI�ailing p�dress Generator's Site Address)rf different than ma ling address) <br /> 5. �ieauty 5upplizs f 744 <br /> 5756 PACIFIC AVE STE 9-1 <br /> STOCR7M, CA, 95207 <br /> Generator's Phone 9n4 457-1nn4 <br /> U.S.EPA ID Number <br /> 6.Transporter 1 Company Name <br /> ALL CLEAR EMARDOOS IFASTE RIVAL IXC CAD982492399 <br /> U <br /> 7.Transporter 2 Company Name <br /> U.S.EPA ID Number <br /> TEKARRY RECYCLING, <br /> THC— >;AR000194217 <br /> U.S.EPA ID Number <br /> a.� 1 a`� )[ DE MEYICU <br /> CAR' ETE3LA_ FEDERAL 90- 2 PWY, SAH PABLO TECATE bC <br /> 619-270-9453 MXC130619001 <br /> Facility's Phone: <br /> 9a. 9b.U.S DOT Descriplion(including Proper Shipping Name.Hazard Class.ID Number. 10.Containers 11 Total 12.Unit 13 Waste Codes <br /> HM and Packing Group(it any)) No, Type Quantity Wt-ftl <br /> C z 1 Capacity) , FLANKADLE, B.O.S - , 2 .i ` 1 P <br /> t- <br /> F003 <br /> 2. CETON <br /> UJ (AE, ISOPROPANOL) , 3, PG II i P <br /> Y <br /> ` �] 331. <br /> (POTASSIUM PERSULFATE, SODIUTI PERSQLFATE) , L P <br /> Y 5 -1, PGIII C � <br /> 1 <br /> a (DETERGENTS.GLYCOLS) �� P <br /> 14.1)a@0911g613oJ11101 dtic�llnfaR;W►, (Aero <br /> Aerosol) 2) R / 1 l X-Z (Fla= Liq) <br /> 3) R 11 C tLlf 6 (Qwidiaer) 4) R f O (MRL-CP) <br /> PRIMARY EXPORTER: TEMMY RECYCLING IBC. PO#13289-1 <br /> 15- GENERATOR'VOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fu6y and accurately described above by the proper shipping name,and are classified,packaged, <br /> marked and iabeledlpiacarded,and are m all respects in proper condition for transport according to applicable intemationaland national govemmenlal regulations.if export shipment and I am the Primary <br /> Exporter.I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgmeni of Consent. <br /> 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 small quantity generator)is true. <br /> GeneraID r sR' ted Signature tli Day Year <br /> JT h <br /> 0-415 <br /> 16.Intern ' al Shipments ❑Import to U. ®Export from U.S- Of enbylexlt: Z 5 <br /> Transporter signature(for exports only): Date leaving U.S.: L I Q <br /> W 17.Transporter Acknowledgment of Receipt of Materials If N <br /> a Transporter 1 Printed <br /> T Signature Month Day Year <br /> O ZG / <br /> a <br /> z Transporter 2 Printed(TypiffName Signature Month Day Year <br /> 36 vsr <br /> 16.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quanitty ❑Type Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number. <br /> lift.Alternate Facility(or Generator) U.S.EPA ID Number <br /> 7 <br /> 0 <br /> rai Facility's Phone: <br /> 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> t- <br /> 4 <br /> Z <br /> a 19.Hazardous Waste Report Management Method Codes(i.e„codes for hazardous waste treatment,disposal.and recycling systems) <br /> 4. <br /> 0 1 2. <br /> T <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item go A <br /> Printedffyped Name Signature Month Day Year <br /> EPA Form 8700-22(Rev.1247) Previoul editions re obsolete. DESIGNAT -T0 EPA's e-MANIFEST SYSTEM <br />