HomeMy WebLinkAbout317497 10/19/2017 4GAA..
''•• CITY OF CARMEL, INDIANA VENDOR: 00352914
ONE CIVIC SQUARE AMERICAN INDUSTRIAL SERVICES CHECK AMOUNT: $ ...2,300.00*
_? r� CARMEL, INDIANA 46032 8500 GEORGETOWN ROAD CHECK NUMBER: 317497
+y INDIANAPOLIS IN 46268 CHECK DATE: 10/19/17
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
601 5023990 366403-01 2,300.00 OTHER EXPENSES
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INVOICE
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TOLL FREE 140"77.4l5S
INVOICE NO: 36W403-01
INVOICE DATE.1013112016
CLIENT:
PROJECT INFORMATION
MK LAMES ALFORD PROJECT ID:
CTCY OF CARMEL ITCILITIES DESCRIPTION: CHEMICAL DISPOSAL
3450 W.131ST STREET I..00.`ATION: CARMEL
CARMEL,INDIANA 46074
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CONTRA<k CNOICIt4I515
CONTACT: JAMES ALFORD PROJECT MGR:GREG SPEARS
WORK PERFORMED THRU: 10/20/2016
WASTE MANAGEMENT SERVICES
DESCRIPTION UNIT QUANTITY PRICE"IT TOTAL
CHEMICAL DISPOSAL 1.00 $ 2,300,O $ 2,300.00
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TOTAL
y •3 INVOICE $ 2,300.00
TEAMS. NET 30 DAY$
Y LATE PAYMENTS KILL BE CHARVED INTEREST AT 1.5%PER MONTH
REMIT PAYMENT TO: AMERICAN INDUSTRIAL SERVICES,8500 GEORGETOWN RD,INDIANAPOLIS.IN 46268-1647
NON-HAZARDOUS 1 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Waste Tracking Number
WASTE MANIFEST
5.Generator's Name and Mailing Address Generator's Site Address(ifi event than mailing address)
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Generator's Phone:
6.Transporter 1 Company Name > U.S.EPA ID Number
7.Transporter 2 Company Name U.S.EPA ID Number
8.Designated Facility Name and Site Address U.S.EPA ID Number
Facili s PhoTTA.
9.Waste Shipping Name and Description 10.Containers 11.Total 12.Unit
No. Type Quantity Wt.Nol.
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13. Special Handling Instructions and Additional Information
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14.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.
Generators/Offerors Printed/Typed Name SignatureMonth Day Year
1 15.International Shipments
i�- ❑Import to U.S. y ❑Export from U.S. Port of entry/exit:
z Transporter Signature for exports only): Date leaving U.S.:
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16.Transporter Acknowledgment of Receipt of Materials
Transporter Phnte&Typed Name Signature ' Month Da Year
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a z Transporter 2 Printed/Typed Name Signature --'' Month Day Year
17.Discrepancy
17a.Discrepancy Indication Space ty ❑Type
El Quantity El Residue El Partial Rejection Full Rejection
Manifest Reference Number:
17b.Alternate Facility(or Generator) U.S.EPA ID Number
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18.Designated Facility Owner or Operator:Certification of receipt of materials covered by the manifest except as noted in Item 17a
PrinteCyped Name Signature Month Day Year
GENERATOR'S/SHIPPER'S INITIAL COPY
Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039
UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number
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WASTE MANIFEST ;+; , ; �+tJ bJ -, ` .
5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address)
Generator's Phone:
6.Transporter 1 Company Name U.S.EPA ID Number
7.Transporter 2 Company Name U.S.EPA ID Number
B.Designated Facility Name and Site Address U.S.EPA ID Number
Facility's Phone:
ga 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes
HM and Packing Group(if any)) No. Type Quantity Wt.Nol.
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14.Special Handling Instructions and Additional Information
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15. GENERATOR'SIOFFEROR'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)or(b)(if I am a small quantity generator)is true.
Generator's/Offerors Printed/Typed Name Signature
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—J 16.International Shipments
❑Import to U.S. ❑Export from U.S. Port of entry/exit:
Transporter signature for exports only): Date leaving U.S.:
LQ: 17.Transporter Acknowledgment of Receipt of Materials
Transporter 1 Printed/Typed Name Signature
ont ay Year
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U) IMonth Day ' Year
ZZ Transporter 2 Printed/Typed Name Signature
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18.Discrepancy
18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection
Manifest Reference Number:
18b.Alternate Facility(or Generator) U.S.EPA ID Number
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Facility's Phone:
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C7 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems)
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3. 4.
20.Designated Facility Owner or Operator: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.3-05) Previous editions are obsolete. GENERATOR'S INITIAL COPY