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HomeMy WebLinkAboutWaste manifest Spot Food Mart Job 3-2024&g-THEA#R?F°Egi 1,=Ge::rat::'D!Umger3 + 7 : i 5 5 |2Pao.e'°f %„E3::.g3n4C?,£P::=P:nseph°ne 4ivwtw#T=kjgN#r# #4/B~ EL ,h` 5.G!#8±at.gf:,¥€a¥S#3Mr,Sl±np£A{drq,less #tt = i-:BL!!' g': ` !i Generators site Address (if differenHhan mailing address)•,`r`.',',\\•1?i)'-,{iij; •':,JF,z5';3 .;,;{dS!€:jr,. F?.]a..i t±I-zg}...ergfjE!E! I.#. 9:3:3!J::i Generalor'sphorie.. r '] 7 T' `' i -r]. =.!J.L= I 6 TBn#i|%ipt?¥P£.§yaya:%.i:=:;:a }r,= , Uf. E,=A'F:Nugbe|=,.:i 1, i i.. :jt ,:, i+i^'''.+I,<,.d)`t-I,+,\,•\,;i`);</'|f,(L¥,\-Jt,I_'y;ii~:i,!j,,,I;.(+`J;•`?:i•,Li!i'ff<):a,£*!•'*,i;ji;;%¥..jtJ1?*r?ti#;i;;i-%i;i?;I(+:a 7. Transporter 2 Company Name U.S. EPA ID NumberI 8.D#gfgiv Eapi!9rD|ariaf.pd site Address u.s. EPA ID Number •:.::a ;,,{','' i...,i i=.r(t€, i.t,.enu€ i;i::n=.;ii;r{€ii.!=:i`, f,=fa 82:3.1 E! Factl-rtytsphon©: .="±'! +:1"3[i{.i I i= `L =i `] = I .: A I .i ,=J i 9. Waste Shipping Name and Deson.ption 10. Containers 1 1. TotalQuantity 12. UnjlWt,rvol. NO.Type` i`i{uiN~ i+hL^TL9tv5 N^£r& 5gi', 8 trf uiFiTrm) Ocl in V®&y. 2. 3. 4. 13 spec,ai Handling lnsiructions and Addltlonal lntormat'°n , I a ]± a tyoac7C)7 \"!f: r,,,Z-,!``J':; BIN #Ll 0 &S14GENEBATOR'S/OFFEROPl'SCEF!TIFICATION.lhbdIthh Ii;; rna . ere y ecare att econtentsofthisconsignmentarefullyanrkedandlabeled/placarded.andareinallrespectsinproperconditionfortransportaccordingtoapplicableiriterd accurately desnationalandnaticribed above by the proper shipping name, and are classified, packaged,onalgovernmentalregulalions. Gonerators'offerorspmtedITyped"ame sttR¢KRT , s'gnature -.-. -----.--. ,6o3th I #D3 I 2Yef; Iia 15. Intematlonalshlpments I importto u.s. I Export from u s Portof ent /exit. Transportor signature (for oxport8 only): Date leavina u s '•7'-¥`,,:`[`,,:,a-:,;;; a:EaacOZaCEI 1 6. TraTn§porter Acknowledgm8nl of Pleceipt of Materials oT+?rins:rti=rri::|yp=`Nam;ca€L , S%Z=,-'~,-,-~ ,:~.- I ;o3h , ¢Dg I 3y;r `'._ci Transporter 2 Printed/Typed Name SignatureI Month Day YearIll :`§!f;,I 1EIaaLLJEaaffaj 17, Discrepancy •¢'% 17a. DIScrepancy lndicatlon space I Quant,ty I Type I Residue I partlal Rejectlon I FUH Rejectlon ( Manifest Beference Number: \\I,`t,'^.#•:I/F;,i€,•fjI-\:I; 17b. Alternate Facility (or Generator) U.S. EPA ID Number Facility's phone: I ,` 17c signatureofAltemate Facillty (orGenerator) , , Month , Day I Year :i:i:,4 .(izt.f'+r=J%,,`i?.?r`:•#!#, I),,Z.;,9 18. Designated Facility Owner or Operator.. Certification Of receipt of materials covered by the manifest except a§ noted jn Item 17a Pnnted/Typed Name SignatureI Month Day Year i:Ill 169-BLC-0 511977 (Rev. 9/09) BES§SNAITED FA`®!EL§TY IT® GENEENjqff®gR :(-:;zf:.,i,.:I_,i\,`,;,%!Jt:a`'f.,i•S`"i.;'i,J^.';!}ii-;;`,!;,`-?j:;(;iii:ii.?€?;):i',fl+',.{:;.iJitL/I,;t,`,-J:\€I;;itr.`,#4'`-;iiijh`'8jI,,,NON.HAZAF|DouS 1. GeneratorlD Number 2. Page 1 of 3. Emergency Besponse phone 4. WasteTracking Number WASTEMANIFEST -i i I. ,1 i 1 -~ 2 -: :. t. frr_,.-1_.:,:..-r, ,I-;. -.i~ I:,`„/'''] 5.G :::;at:r s+ ::mce.a:d.,M,a,:,lI::itA:rdr:SS +`{: =._ =. j`.€`L i. , , Generator's site Address (if different than rna"ing address) tv:;i -,-.-,E,L-1, ,., I.-. ;..., ,.a, - . L£:Eif:'i8i;,...,!!=;=,r.i=.I,=::: P3,3;.,.= r5-'`!€ ,I....j ..:':,..+,. ,;,.:.,..: ,i, ; Generator'Sphone: -..:..,-; r-..-,i L-:.-:rir I 6. Transporter 1 company Name U S. EPA ID Number f,)(A\,i.3\3h`ia€S•')i',I#?A,)ii;•;,7% Er.,rf+Lfzr.:.+€r..+a' :_1.3.=!i=.i;...i~ .r..I. I.-.-.` I+ r! :~! :~~ `` ~' `~, ; :i; „ 7.Transporler 2 Company Name U,S. EPA ID NumberI 8.Fac ignated Facility Name and sit© Address U.S. EPA ID Number i ~± 3: rr, 3= T5[} F ; r; i=. a.jE '`f''`i ; i``.f: Ifr;tEi .A.`tH3r:ij.a i:i:Irii.;r!£€`!.i=!ri .=;,i .:{2'=.:18'sphone: .,=il.I i!`-`;`-i,.i`..I -. . -.-. -.. --. 9. Waste Shipping Name and Descn.ption1iv#Nif,q2,ki®OufwftITE 5¢L;D cBRE6 r"Gil)10. Containers 1 1 . TotalQuantity 12. UnitW'.rvoI' . .-I 1 NO.Type 00!u#a¢y 2. 3. 13.S 4. `lH' e a ln rucionsan iiona normaion !! f=t#:9]=c9-I:His" * a#Fffi leELatycpp07OG 14.ainGENERATOR S/OFFEROB S CEBTIFICATION: I hereby deelaro that the contents af this consi'gnment are fully aarkedandlabeled/placarded,andareI.nallrespectsjnproperconditionfortransportaccordi.ngtoapplicableintond accurately dmatlonalandna ribod above by the proper §hipping name, and are classified, packaged,nalgovernmentalregulations. enerator§/offeror§PnntedrtypedName sitpdiKptT , S'gnature I._~ tt , M;5n , gDi; , Zeady '?€!'ti\'TS 15. Inlematlonal shlpm6nts I Import (o u,s, I Export from u s Portofentry/ex„Transportersiqnature(forexportsonlyt:Dateleavingu.S.. ;ii.1:.I:.i 16. T,ansporter Acknowledgment Of Becelpt Of Matonals TransPorterlpmtodITyp8dName (/Lj\t ITfr` ,S'gnature ~~~ ~.=-~~.^+- ,¢M°ih,d€ay , Ze# *3+,i¢;a. Transporler2PrintedrrypedName Signature C~ Month Day Year ,1111 ;;;i;!E3±i:3j!'®ii 17. Dlscrepancy 17a DIScrepancy lnd`Catlon space I Quantity I Type I Residue I part|a| Rejection I Fun Rejectlon °(``~\`€-£``f`(#ii 17b AI Manifest Reference Number:. terriate Facility (or Generator) U.S. EPA ID Number Facility 1'sphone'I 17c signature of Alternate Facility (orGenerator) , , Month , Day , Year } 18. Designated Facility owner or operator: Certification of receipt of materials covered by the manifest except as noted in Item 1 7a : PrlnledITypedName , Signature , Month , Day , Year i 169-BLC.0 5 1 ig77 (Flev. 9/og) DES!®RE/1.TED FAGBEL.IITV ITS GENE#TEfEur®m STRAIGHT BILL OF LADING-ORIGINAL-NOT NEGOTIABLE CAFIBIEF] TO coNsiGNEE ¢]e`€e ` im c.oy`p®ha, STPIEET `Z`€ a. to\o``ir€ |®J"€ 9V`O¢€ '. ¢Sti.\ a. u `|-4\4\ a ` 8QkeQs.F`eiDESTINATION STATECV} ZIpq33ol SHIPPEPI N CARF}lEF} NO. FROM c\AL. ®oo4|'2.4leqsHlppEFl i\+€ s9ol FOGS -my`q.i STREET 3¢¢j4 \,J`|Sop `TZ.¢v`3> p\`Otoe : i 01-ttl -uJios oPIIGiN B®vees€`e.tis §TATECJS ZIpq.33o|F30UTE Flemit COD to: Address: CLalw itBc,rtitBLe Col,c,ruzT`€ 3Ij`Lil,-(,tl''ch VEHICLE NUMBER U,S. DOT Hazmat Beg. No State: Zj NOTE: Where the rate is dependent on value, shippers are required to state agreed or declared value of the property. The agreed or declared value of .the proberty is he-r6b;apcoifically in wn.ting the :_:--:::i::--::-:--:-::`::::--::--:-:-;:::-::----:-::i-`:--:::-:``--::-_-::.::-::::::: TOTAL CHARGES: bFTEEEHEE+HEEii"ELiFEHqEfiEi!HFififflF"[TjEimHLEHffi|!ifTREREiEififl!EEHHwlniEiEEHEThEEEFiiTi¥FFfiiiFEFEL|NFTEB,|ELifH=FH]FTE COD FEE: prepaid I collect HS FREIGHT CHARGES E prepaid Ecolect packages unknom), maii(ed, conslgn®cl, and desthed ae lndlcatarfogfer*r-h°£oi:-dr:riig,-*rg-ud;3gn.*'°ali..it':.8-L*Erd€.fr:¥j#o£°to£#a##.i#;'§:Chnang?r%j:#nror#eEi:3£#::a?:%¥:°dE#t¥toB£#£gg#o!er#Tn##hgTg¥w%h¥icg:¥£y%°#¥£n't#eLsfchTrpn:¥r::#y££t:8a¥o?P::r#Tgn:a n8, NOTE: Llabillty umrtat[on for lo®B or damage ln thlo ®hlpmont may bo appllcablo. See 49 u.e.C.147co(G)(1)(A) arid (B). This is to certify that the abc>ve-named materials are properly are jn proper condition for i classified, described, packaged, markec!, ancl labelecl, ancl circ wi pruper conai[iori Tor [ransportarion accoroing to the applicable regulations Of the Deparment of Transportation PEB: SHIPPER: isu.V>ukY`|cNRIFurHIt. 8 LJ_ pEF=: ` I A J PEB: fJ4~ CL.`Ga\SE. ,.i Dr±_ ff -J ~ os-- 2`{,i.Li EgELEEffipGFTE®NN®EVNmuEMsggff:sE 8 c>®., 424. c\sO a g#REOETggReu®NNaa%AEqgERENUTifFEEE : 11-BLC-04 12277 (Rev. 9/10)i] =/;,:,:i:i(_i,`r,;,:,?iI:3`i!i-I,,v';i-+;I-',#`\1,h=,.iij::-,)I/'.`•/,'•#:i,`;,.`.+,`.`t,,i:;zii:?.yl`L\S-,T`,(Aky):-`i3y?!?i;;i#`,1;i;ij:•i?i?jg;;;:;i€!k`. #ig-THEAEARPF°Egi t,fe::rat::'D,:um8er a i 7 2 € E, 5{ 2 Pag?t°f| "mergfnfyo:e¥SE°,!S.8gp!`:;.3 I 4.WasteT,r`ic#,ng_Nu=beE +3 E, E„ g 5. a??8&atgs!§T9£gdavgili£#Thd,r£S§ j*.H: =r!E'Jl{.3[ a.!! Generators Site Address (if differenohan mailing address) :3888 !„dvi!5an F3a2SIi Ba}``gr_#e!d f=.A £330a Generator'sphone: T!]? I:/i-J3!!]5 , 6 Tr±n;,i,:jrtr°:Tr{?.:..mep#€ygTa[egfj{ at] r:3 , nE , U,=. E,£A 'ENumber t,:,i.I,!3.i?2/i£!J:i( 7. Transporter 2 Company Name U.S. EPA ID Number ;Ii 8. D#:S2a!, .!Squ?rfgd slte Address U.s. EPA ID Number •i 8t} I/i,J. i.`!i cjr!±a ji..{.!.g.ri!ijg \, E•icn:`t-{iirig£€tr` t=£. a.23 'i E` ;; Faciiity'sphone E}!]E' ¢:t-2]f= I .I-,dr I. g: a i ,£ i ,i ,i a +i ; 9. Waste Shipping Name and Description 10. Containers 1 1 . TotalQuantity 12. UnitWt'IVoll d`*( No.Type- i-i --i .:+::a.i,-N ;-.5, TE=- i :-. - .: i-= := = .i`. i.i €.-) c,Oi #m 8„y '(.^i;£i/,',, 2.\L`'`}?t'} 3. `-¢`iJI,(, 4. tL|. 'r\+',+,`,(I;i?)i,,,,,.`,,.)',i ifeH§d\ni;st#s a;;d#£mg;Og-#`| # 5u#8quB u¥± a rpr±tj`„'E[i t=`:3H, ti b=,4F=T , pQEr=#*T\{]qu`t=j `:i•a3a`,iJ'.,y 14. GErnaNERATOP'S/OFFEFIOFl'S CERTIFICATI0N: I hereby cleclare that the coritenis of this con§ignmrkedandlabeled/placarded,andareinallrespectsinproperconditionfortransportaccordingto I,:#entarefullyandaccuratelydescrlbedaboveDytheproper8mpplngname.andarecla§§lfled.packaged,¥\;,applicableinternationalandnationalgovernmentalregulations.``` Generators/Offoror'spmtedrtypedNamo SRA ~ Slgnafure --I ~~. Month Day Year ';,iURAi`.__ ``,`O} ,`O,L( `3£u```.` ?.,' +:1;;E 15. Intemationa' Shlpments I importto u.s I Ex orttrom u s Portofent / 't. -" Transporter siQnature (tor exports only): Date leavinq U S . i-, ff/:,;ru.,clEE'f-,O 16 Transporter Acknowledgment of Receipt of Matenals ;::; TransporterlprirfeurypedName Sign e-.----.-~ -~~ Month Day year L3;J6darif jgi.jde =:=j::_-- ` ur.` ¢.q.``3.,y ,.``Transports)2 Printed/Typed Name Signature Month Day Year :I;::J;IIII:;: ;;1i;;i 17. Discrepancy . :,S;i: 17a DI§Crepancy lndlcatlon space I Quant,ty E Type I Residue I partial Reiection E FUH Rejectlon. i;::;rl`.f.; &?,iManifestReferenceNumber:`;f; 17b. Alternate Facility (or Generator) U.S. EPA ID Number ;t;;;I ?iFacility'sphone:I{t!jj' t7c. SignatureofAlternate Facility (orGenorator) Month Day Year !zsi\;IIIIf,,f- •{'<_?``,I.±`,¢:;;;i 18. Designated Facility owner or operator: Certmcation of receipt of materials covered by the manifest except as noted in Item 1 7a ``+t-'``=`' Printedrtyped Name I Signature Month Day Year }`-;¢;IIIi::;;i 169-BLC-a 5 1 i 977 (Rev. 9/o9) DE§E®REAFEB FAe!ELIThv IT® SENEfflAT®gR Plea epri t typerlease print or type. Form Approved. OMB No. 2050-0039 ctELu=LLJ® uN'FORM HAZARDous 1. GeneratorlD Number 2. Page 1 of 3. Emergency Response phone 4, Manifest Tracking Number wASTEMANiFEST .I. A. L [i E~i `j € T `=' ,i I: !i 1 asi]-£i4J±5!=Z= C244|2630 qJJK 5. Get,e.,r:t°E;£rSa€m::n,:gY§j.!}nag,#d;I?:SS #ttg 5rfaL!l.`=t.A i, Generators site Address (if different than mailing address) :E!39 1.:f;,,qi5;=!n F±i=;.3!j Bali,er5fje!ci Ci`,. {3:3:3#€` Generafotsphone: ? H? £! 2? -6' :J iJ. 5 I 6. Transporter 1 company Name U.S. EPA ID Number Er!t7ircr!menta! LSE!ati£€: !r,£:. I i:r ji.. F`` !] a [i 17 £. ..± 3 i] 7. Transporter 2 Company Name U.S. EPA ID NumberI 8.De ganfte;;:±;acip¥BgFi #.site Address u,S. EPA ID Number 1 ao \r'+/, f,fl. t!ntg .fi.v ertlje B!6.or.:-,i!igto.n i=:A 9€34i 5 Factllty`sphone: 9t!`= 42i-'±rL212 £ .`ft` [\ g` % Z 4 `.1.3 & F£. i 9a.9b. U.S. DOT Deschption (including Proper Shipping Name, Hazard Class, ID Number,10. Containers 11 . Total 12, Unit 13. Waste CodesHMand Packlng Group (if any))No.Type Quantity Wt.rvol. 1. i.,i oniEC:F.4 H azgrtic!u5 i.,kfa§tE i;q;lid r€til..,+` .I.J'.digr,I coli3..-TrRE tyo,E! 22rJ 2. 3' 4. 14. Spiefa±E:;d|:+I}n`gT,gs andAddltlonaUnformation i:!fL.i {=I;i:"¥'},fatgr -:: 128 i 03 tv`',{r`=;. # 3£938`3TB Lj.5E.4PFF3C'`i.+jE=H=`€H#. 3&`FETi`` VT -L| ProF\t€EL aaiaoic>8 15. GENERATOR'S/OFFEROR'S CERTIFICATI0N: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name, art are classified , packaged , inarked and labeled/placarded, and are in all respects in proper condition for transport according to applicable intemattonal and national governmental regulations.f export shipment and am the Primary Exporfer,I certify that the conterits of this consignment corlform to the terms of the attached EPAAcknowtedgment of Consent. certify that the waste minimization statement ident].fled ln 40 CFR 262.27(a) (if I am a large quantity generator) or (b) (ifl am a small quantity generatcir) is true. Generators'orerorspnntedIT"ed "ame =RAftyT I s'gnature -. |M6g |®Dti ,#ffi I=16. lntemational shlpments I ,mport to u.s. I Export from u.S. Port of entry/exit: Transporfer signature (for exports only): Date leaving u.S.: E=LLJ 17. Transporter Acknowledgment of Receipt of Materials =aa.cOZ=I-Transporterl pnntedITme/d N,a}`v 7\ds ,Slgnafure ]Mo;th I D# I;e; Transporter2 PrintedITyped'Name Signature Month Day Year1111 1±I 18. Discrepancy 18a. Discrepancy Indication space I Quantl.ty I Type I Residue I partial Rejection I Fun Rejection Manifest Reference Number: 18b. Alternate Facility (or Generator) U.S. EPA ID Number :CaLu:9u,Luai Facility's phone: I 18c SIgnafureofAltemateFaclllty(orGenerator) I Month I Day I year 19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling syste ms) 1 12 3 14` 20. Designated Facility Owner or Operator Certification Of receipt ot hazardous materials covered by the manifest except as ncted in Item 18a PrintedITyped Name Sjgnafure Month Day Year1111 EPA Form 87oo-22 (Rev.12-17) Previous editions are obsolete. ®ES§©NAFTE® FA©!EL!ffv F© EPA'S ©oELJiAN FE§ff SV§TEiM •i cfa _ --..----------- ` -----------.----------. _ ._ _ _ _ Maranatha Landscape Supply SynLawn 7617 Felipe Coiirt Bakersf ield CA 93307 0rder# 110634 Date: 3/5/24, 2;28 PM.-----.---..------------..-------------.--. _ ~ i!:!o`#is8'!i6.oo $759.00 Discount : -$75.90 _ - . a -----.-------..---------.------.,.-.--- ^ - - _ .. _ Total Item count; 1 _---in-.----.--------------..---.--..I-.-----_____ i#ti!; : S!!! : !! --_-------..-------------~.----------______ Total : $745.72 Customer paid MASTERCARD: $745.72 you saved $75,90!----- I --.----------------.----------------- in - NOTES : Environment logistics (food mart) .`A-----------------------------.---------.- ..-------.---- ` ..-.--.------.- ~-__ Signature I agree to pay the above total amount according to card is§uer agreement N0 REFUNDS 0R EXCHANGES Tliank you for shopping with us! May God Bless You! I_NVQ;Ct 3o,i,,8"P, Maranatha Landscape a Supplies 7617 Felipe Court Baker§f ield, CA 93307 661-363-9638 SAELE MID: 7888 TD: 00F37981 REF#: 00000005 Barfu lD: 000000 Batch #: 1563 RRN: 065071262947 03/05/24 14:29:08 APPR CODE: 71987C RASTERCARD Chip** ** *******.*3719 **r AMOUNT $746.72 APPROVED Ma8tercard AID: A0000000041010 TVR: 00 00 00 80 00 Tsl: E8 00 Thank You Please Come Again CUSTOMER COPY