COMPLIANCE INFO_2022 - Laserfiche WebLink

Home Browse Search

Please print or type. UNIFORM HAZARDOUS 1.Generator ID Number Form Approved.OMB No.2050-0039 2.Page 1 of 3.Emergency Response Phone 4. anifest Tracking Number WASTE MANIFEST ) 729250 G B F 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) AIV V' e171 -77 Generator's Phone. 0 < ' 6.Transporter 1 Company Name - U.S.EPA ID Number 'RAI CIL FILTER RECYCLING -, 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address 1-E; fTAGE-CRYSTAL CLED,M11, U-- U.S.EPA ID Number 920 E flRLMOAGE 'LN Facility's Phone: IAKERSFIELD. CA EI3307 9a, 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers HM and Packing Group(if any)) 11.Total 12.Unit 13.Waste Codes 1 No. Type Quantity Wt./Vol. PDN-RCRA 44T.ARf3OUS 'AASTE YXIDS Z 2. r:r w 3. 4. 14.Special Handling Instructions and Additional Information kL' CbHA hIPROVED SlIVETY PRECAUTIONS Rtt Ile #� 15. GENERATOR'S/OFFEROR'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 labeled/placarded,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 this consignment conform to the terms of the attached EPA Acknowledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)orb if I am a small quantity O( q ty generator)is true. Generator's/Offeror's Printed/Typed Name Signature Month Day Year 16.International Shipments 3 Z ❑Import to U.S. ❑Export from U.S. Port of entry/exit: Transporter signature(for exports only): Date leaving U.S.: LU 17.Transporter Acknowledgment of Receipt of Materials � Transporter 1 Printed/Typed Name Signature O Month Day Year IL P Z Transporter 2 PrintYPed ed/T Name .: Signature 18.Discrepancy h Day Year.-�• -�.-..''»s�".y„!�...,`, ,_..,_ Mont tl M1 , f- 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection 1 El Full Rejection 18b.Alternate FacilityManifest Reference Number: (or Generator) U.S.EPA ID Number U LL Facility's Phone: W 18c.Signature of Alternate Facility(or Generator) Z Month Day Year N19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) LM 1 2. 3. 4. 20.Designated Facility Owner�orOperator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Printed/Typed Name Signature Month Day Year EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. GENERATOR'S INITIAL COPY