Laserfiche WebLink
Plpac� ndnl r,r h,�a fFnmn damaned for use on elite (12-oitchl tvaewrlter.l <br />Form Approved. OMB No. 2050•DO39 <br />EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DES1Gi'IATED FACILITY TO DESTINATION STATE ((F REQUIRED) - <br />UNIFORM HAZARDOUSAC <br />El.�G,,e,ralor ID Number <br />0 0 2 9 0& 8 9 0 <br />2 -Page 1 of <br />1 <br />3. Emergon Response Phone <br />(SOti} 4-'4-93170 <br />4. Manifest Tracking Number <br />016772767WASTE <br />JJK <br />MANIFEST <br />S.Generarla arie�i tl r tiE' l- Genera toes Site Address (ddffcrenilhaoma7ingadtlress) <br />( D. u7AtDE <br />8476 E. iTl—LENIAN LANE <br />LOCICA C,E240 <br />. -A9�Ja! Old <br />Generator's Phone: <br />6.7ranspat6,urq,Tfy�INyarjR0NMEMTAI_ SERVICES Iter erg 8 2 7 7 0 3 6 <br />7. Transporter 2 Company Name U.S. EPA ID Number <br />6.Desigrtat d,.WGIkNa i Mt` (l�IVs U,S.EPA IDNumber <br />2000 N. ALAMEDA STREET <br />COMPTON CA 90222 CAT080013352 <br />Facilllys Phone: (310)537-7100 <br />ga <br />9h. U.S. DOTDesaiption (indudirg Proper Shipping Name, Hazard Class, ID Number, <br />10. Containers <br />11. Total <br />12. Ung <br />r.3, Waste Codes <br />No. <br />Type <br />HM <br />and Packi"Group (itany)) <br />Quantify <br />WtNot. <br />1. N N-RCRA HAZARDOUS WASTE, LIQUID (OILY VVI ER) <br />223 ` <br />-_ <br />p �f <br />,s <br />6 <br />-__-- <br />2. <br />LLI <br />--- -- — <br />3, <br />4. <br />- <br />I <br />i <br />f <br />14. Speoal dandling Instructions and Additional Information <br />EMERGENCY CONTACT: CHEMTREC 1-800-424-9300 PROFILE N 981: 033017-01 OILY (NATER" - APPROPRIATE <br />PERSONAL PROTECTIVE EQUIPMENT 2-01 <br />15. GEN ERATOR'StOfFEROKS CER71FICATION: I hereby declare that the contents of Hs oDrisignment are fully, and accurately deWbad above by Itio proper slOpping name, aid art- dassifled. packaged, <br />marked and labeledlplacarded, and are in all fespeds in proper condtion for transport according to applicable international and national governmental 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 EPAAdabWedgment nsenl <br />I cattily that the waste minimization statement identified in 40 CFR 262.27(a) (d t am a large quantity generator) o dl small anti ) is true. <br />Generators! ors P ' tedfT d Name ignetu — Month Day Year <br />1 <br />16. Inlemaknal Shipments <br />❑ Impar to U.S. ❑Export from u,s. Pmloi entry/e ' <br />Transporter signature (forexpods only); Date leaving U.S.: <br />17. TransporlerAcknaw[erk3menlof Receipt of Materials <br />Tr a sporter 1 Pd tedrT Name Signature J Month Day Year <br />aAV <br />I�t (—Eve o (� -17 <br />Transporter 2 Printe d Name Signature Month pay Year <br />r- <br />18.Otsorepancy - <br />16a. Discrepancy Indication Space ❑ quantity Typo ❑ Residue❑j Partial Rejection ❑full Re action <br />ManYest Reference Number. <br />18b. Alremote FarZty (or Generator) U.S. EPA ID Number <br />V <br />w <br />Faalily's Phone: <br />W <br />18c.SignalureolAllemaleFacility(or Generalor) <br />Month Day Year <br />19. Hazardous Waste Report Management Melhod Codes (i.e., codes W hazardouswasle treatrnent, disposal, and recycling systems) <br />In <br />1. <br />2. <br />3. <br />4. <br />20. Designaled Facility Omer orOperator. CaMcation of receipt at hazardous materials covered by the manifest except as noted in Item 18a <br />Printedrfyped Name Signature Month Day Year <br />EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DES1Gi'IATED FACILITY TO DESTINATION STATE ((F REQUIRED) - <br />