Laserfiche WebLink
Please pdnl w type.(Forth designed for use on We(12-pitCh)rypewritec) Form Approved,OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 7,Genmator ID Number2.Page t of 3-Emergency Response Phone d.Main <br /> Trickle Numha <br /> WASTE MANIFEST CALOOD269375 1 877-737-5277 011179980 JJK <br /> G&h0fZorS Sae AGdress(A Werent Mn meain9 ad ) <br /> S.Sxrer�mrska�eW Mafn9 Wdoclhon 3927 Clark Drive Attn: Douo Grose <br /> 3927 Clark Drive Stockton, CA 95205 <br /> Stockton, CA 95205 <br /> Generators Phone: 91#1 San—ia/!+5 <br /> 6.T.Sponer i Company Name U S.EPA Q Number <br /> Worldwide Recovery Systems, Inc. -.: , �; _ .. -- -CAR000175422 <br /> 7.Tmnspale 2 Company Name U.S.EPA IC Number <br /> Maumee Empress, Inc. DEC 3 ZO1F; NJD986601380 <br /> 8.j� &araky Name and Site Address U.S.EPA;0 Number <br /> 1007 Vulcan Road-HaskellEIVV�FdORIf�4FIVTr�_ )..,EA�•IF <br /> Benton, AR 72015 ( „ <br /> Fouill Is Phone: 800-377-4692 r_ F�`n�'- .,�,!,'V.vTi MD981057870 <br /> 9x. 9b.U.S.OOT Dasa&"(hMudng Proper Shipping Name.Hazard Cass.D Number, F 10.come— it.Total 12.Und 13.Waste Codes <br /> HM and Packing Gmup It anY)) No. Typo Cuantry YrtNd. <br /> I UMV91, waste EXEMINca4•, , n.o_s. n <br /> o q (petroleum Distillates, Minerel Spirits) , , 3, <br /> PGII An <br /> w 2U� ryS°j We-She-A�et�alj, F/...rl.+��6/�� <.:� d7oof 3Jr <br /> Ad >L -esFCeed:S rL <br /> 3. <br /> 4. <br /> 14iSpewl HandGnq,hsinrdow entl AtltliGonal mfnrnenon <br /> 128; 1010-139 2 9 'L� fooY-oS"Sly <br /> Bill to Worldwide; Hear Appropiate Protective Clothing; ER Response0 oxldmide Recovery <br /> Sys, Inc_ ; Haste Pickup/)dc, ID@ 251541 <br /> 15. GENERATOR'SIOFFEROWS CERTIFICATION: I thereby dedare that the oontents of dins P,gr mrt are July and acaraley CescMed soave by 019 pmpa shipping ho m,and are dassiiled.paok39ed, <br /> marked am IebeledlpmoaNed.arm are in at respects H proper condition br napod acmrdng b applicable International and nalmnal 9wemmenml m ulenpra If es l shipment and I am the Primary <br /> Exporter,1 adiy that the contents of lee awgnmenl wnfonn to the terms d the atzcbed EPAAcknowfedgmenl of Conserv. <br /> 1 cony low the waste mirwaston statement mariff ed 6140 CFR 262.27(a)(6I am a large quaMty gemrdor)a(b)(111 am a sma8 quan6y generates 1s Nae. <br /> GeneresJOIlerots Prinledayped Name Sgwtum Month year <br /> l <br /> a <br /> 16Antemaeorel Sbipmente ❑InNiorl ❑Eapod U.S. PMMA .IL <br /> Z Transportar slprae re(for expMA only): Dare low,mg US: <br /> Ir 17.Trempu1e Adr4ysledgmmo of Remim of Matehals <br /> Trawpafa 1 Prim wlyped Name / Cgna4ae MmN Lay Yes, <br /> d 1/I"J ,C� ld ZZ I L3 <br /> 2 Tnnsponer2Prml ypedName Syralwe Monty Day Year <br /> t , io 129113 <br /> 18.Discrepancy <br /> 183.Dlsaepancy Indiatm Space ❑ Ouamty ❑TYPm ❑Residue ❑Peru Rejeoton ❑Fut Rejecnah <br /> Manifest Refarenre Number: <br /> 1eb,Alternate Faddy(or Genmalor) ;. U.S.EPA ID Nhanber <br /> J <br /> V <br /> Fadm/s Phone. <br /> w tk.SgnaW2 W Alternate Faefaly(or aralu) Monty Day Year <br /> Q <br /> 2 <br /> H19.Hazardous Waste Racal ManapemmfMethod Codes(i.e.,odes fa naumpus waste bealmenl,dhsposaL and recpinp systww) <br /> 7 2. <br /> 20.Desynated iy Oane for Cntifralion of receipt hanrdaus a%MW mrQmd by the mantes! s Med in Nem 18a <br /> PoMedlr a SipnaW Mon C <br /> EPA Foran 8700- (Rev.305) Pmvious editionsobsolete. <br />