HomeMy WebLinkAboutveoliaQ VEOIIA
ENViRONMENTAI SERVICES
TECHNICAL 50LUTIONS
NORTH AMERICA
Customer:
FUTURE ENVIRONMENTAL
1055b COMBIE ROAD #6250
AUBURN, CA 95602
Tvae
incineration -PCB Ballast
Generator:
BUTTE COUNTY FACILITY SERVICES
2279 DEL ORO AVENUE
SUITE F
OROVILI_,E, CA 95965
Veolia ES Tecl~n~cal SoZut~oris, L..L,C.
AZ0000337360
Certificate of Receipt/Recycling
ManifestlBOL Number: 006962805.~JK
uan#i Unit of Measure
290 P
526267
D726296
Serial Number
D726296-1
Sy this document, Yeolfa ES Technical Solutions, L.L.C. certifies that the above listed items/wastes, as
described on the shipping paper listed above, were received for recycling/pracessing on the below listed date. By
accepting the itemsfwastes listed above, Yeolfa ES Technical Solutions, L.L. C. certif es to the generator that the
transportation, receipt, storage, and processing methods employed are in accordance with Yeolfa ES permit parameters,
the Toxic Substance Control Act, the Resource Conservation and Recovery Act, the Hazardous Materials Transportation
Act, the Occupational Health and Safety Act and all applicable federal, state and local laws.
Upon receipt of the final certificates of disposal from the ultimate disposal facility, Veolia ES Technical
Solutions, L.L.C. will provide a tracking report for the materials received and copies of the frnal Certificates of Disposal..
I certify that the information contained in or accompanying this document fs true, accurate and complete.
~~~ ~~
Operations Manager
Date Received: 2/4/2011
Veolia ES Technical Solutions, L.L.C.
5736 W Jefferson Street, Phoenix, AZ 8So43
tel: 6oz z33 2955 - tot I free: 800 368 go95 - fax: 6oz i5 30
www.VeoliaES.com ~ ~ ~ /°l~ ~~ ~. ~ ~~
YGro~lec"iirinlrrlvnb (Fnnn rtncinnarr fnr i ten nn nlife !19_niMhl h.nnumfor 1
Cn.m 6nnrn..e.~ nAAO A7.. encn nrton
UNIFORM HAZARDQUS 1• Generator ID Number 2. Page 1 of 3. Emergency Response Phone b. Manl[estTracking Number
WASTE MANIFeST ~:,~L4~~''~t- f ~1~-~6-f795 ~ Q ~ ~ ~ ~ Q 5 JJ K
S Generators Name and Mailing Address Generators S'ste Address (if difterenF than mailing address}
Bf.i r 1E L"~tlfslTY ~CtRRQ CsF ~Lii~ER'Vi5uR5
~'a ~t3UNT~Y GEi~'t'i=F: C!R- ~?~ i31wL ~'iR+~ {~tt~.. STF. is
~SRr~VE[.Llw, C.A +565 USA 5.~5.~-"1i3 C~Rr'lVii.3.E,
Generators Phone:
6.7ransporter 1 Company Name " U.S. EPA Ib Number
FU'[LtRE EtoJklf~tEPVTP,L ~Ef?1pQ~ t;l'iExCrCtD4~'?0',e5
7. Transp rter 2 Co pang Name ~ ' U.S. EPA ID Numhfer~ Q/y, /~
8. Designated Fa 'lily Name and Silo Address U.S. EPA ID Number
x.~~l~t E~ Ti;CHhllc:,~ ~t~1.U1T~PJ~, ~Q
57~ i.'U JEFF~Rs~M ~'T. At~>Q~la"6£1
facility's Phone:
ga. 9b. U.S. DDT Description (induding Proper Shipping Name, Hazard Ciass, ID Number, fll. Containers ii. Total 12. Unit 1
HM
and Pack+ng Group {If ahyj}
No.
Type
Quantity
WIJUoI. 3. Waste Codes
~ X 1. F.~. PLYfwYGF{t.,~RlitEr~T~[>; RiF'iiEf'fYl., ~, UN2.315, r~.G.IN (F'L:B lir3Kl`
^
/
Qfvt {~j2
i{ ~t5'i
~1..~,
sTJ I' ~Sw~
~ 2.
w
c7
Q
3.
i~
4.
14. Specal Handling In3tiudians and Additional information
S~iJ~ PRt~FJL~!#25~~ YyfiRREiFI 5{1$9 Rr~~EFiT~
tld~k~t P1~t~P~R P.P.Q.
TtsPt3i # ~~ QS ~ - ! ~ 5 ~ • f j ~
~
~p I b,
_ 15. GENERATOR'SlQFFEROR'S CERTtFlCATION: Thereby dedarethat the contents of this consignment are fully and accurately described above by the proper shipping name, and are dasslfied, packaged,
madked and labetedlplacarded, and are in all respells in proper condition for transport according Eo applicable international and national gvvemmental regulations. If export shipment and I am Itie Primary
Exporter, l certify that the contents of tltls consignment conform to the terms of the attached EPAAcknowledgment of Consent
I certify chat the waste minim'aation statement identified in 40 CFR 262.27(a} {d I am a large quantity generator} or (bj {if I a small quantity g r) Is true. . ~-
Genera s! rots l~rintedffyped Nam, ~f Month Day Year
~
~
I `'~
~~
~ 16. tntemational Shipments ^ Impor
t to U.S. ^
Export from U.S. Port of entrylexit:
Z _
Transporter signature {for exports on[y): Date leaving U.S.:
w 17. Transporter Acknowledgmerit of Receipt df Materials "
~ Transporter 1 Print~edf7fyped Name S" Month Day "Year:
Printadliyped~ e~ ~.. ~ Sig ~ Month. Day Year
rskxapancy ,
iBa. Discrepancy Indication Space ^ Auantity ^ Type ^ Residue
^ Partial Rejedion ^ Full t2eJedbn
Manifest Reference Number.
186.A1temaie Facility {or 6eneratarl U.5. EPA ID Number
J - ..
C7
Fadlitys Phvnv:
w 18c:5ignaturevFAltemate.Fadlity{orGenerator} ~ Month Day.:" Year
a
z
19. Hazardous Waste Report Management Meftxrd Codes (.e., codes fw hazardous waste treatment, disposal, and recyding systems}
~.
~ .
1. ~ ~~ ~
2:_ - _. _.
3. 4....._
20. Designs aril-shl Owner ar Operat don of receipt of hazardous materials covered by the manifest except .n in Item 1 tie
Pdn Na ~ Signature ~ Month " Day Year -
nn rn_.. a neA~ n~,__..~ _~:c___'_'- _ .. -
-...._....-•--.-~•-------, ----------•--•'--•-----•---• j tUC,~ItSiVAi,GUtAC:IWIY EtJlsthltli'ATOFi