Laserfiche WebLink
OCT-27-2008 18:25 CITY OF LODI 209 333 6710 P.26 <br /> .Ole t or a.(Form designed for use on ellte 12-pI0chhewdler.) Farm Approved.OACR Na.2050-0039 <br /> s 1.Generator 10 Number 2.Page 1 of 3.Emergency Response Phone 4.Manlhst Tmc ng Number <br /> UNIFORM HAZARDOUS CAP98367260'1 I f" J J K <br /> WASTE MANIFEST T T-80f1-46S— 760 <br /> 5.Generators Name and MallingAddress cw'xgd1Dr�lre�EI d"r� malIingaddress) <br /> y CITY OF LODT R V <br /> 1331 8 HATE LANE ATTN ROGER <br /> LODI CA 95240 <br /> Ganeramrs Phare: 209-333-69,10 <br /> 6Transavl an Name �, U.S.EPA ID Number TXt2000050930 <br /> SRFE7 K E N SY9TET% lY;C <br /> 7.Transporter 2 Company Name NIH4NfC11yAL Z U.S.EPA ID Number <br /> t � <br /> s.Designate dFadiibyNemo and Site Address SAF7ETY—KL,EEN SYSTEMS. It4C. 000760 U.S.EPA 10 Number <br /> 6000 88TH STREET <br /> SACRAMENTO CA 95828 CAQOOOO6+4517 <br /> Fa01G sPhone; 916-3i6-4913 <br /> ga, 9b.U.B.DOT Description(Incbding Proper Shipping Nemo,Hazard Clem,10 Number, 10.Call aa 11.Total 12,Unit 13.Waste Codas <br /> HM and Packing Group(If any)) No. Type Quandry WlJvol, <br /> x X �WARZ US UASTE, LIQUID, K O_ S. DF C ll <br /> o 9 NA308' FO III t6039)(ERG#5171) <br /> AOUEOUS SRAKE SOLUTIOH(8, 3#113AL) O <br /> 2, <br /> 3. <br /> 4. <br /> 1N 14.Special Handing lnsuuctdnaand Additional Wormsaw SK TRC9#107 06673 0032823654' 00003707976644 25 <br /> cALtTNRFTAIN LICENSED SURSEQUE14T CAR. I RS AS KlQE5S8Ry <br /> 15. GENERATOW61OFFEROR1 CERTIFICATION;Iheteby declare that the contents of Mls mmIgnmenl over fully and amurelaly described above by the pmWshipping name,erd one classified,packaged, <br /> marked and labeledlplacarddd,and are In all reepecte In proper mndldaa for tranepat according to applicable Imornatianel and mIonel goyammernal regulations,if export shipment and I am the Primary <br /> Exporter,I carlHy that lheoartmIa of this consignment Conform to the terms of the attached EPAAUrnowledgmilt of Caresnh 1; <br /> I car6fy that the waste minimization statement Identified In 40 CFR 262.27(a)Of I am a largo quandry generator)or(b)aft am a amall quem namfor)Is <br /> GeneralatslOffarors PdnWYP.ed Name Signature �' Month Day Year <br /> tea. Lh li" , ,. zz IQ/ <br /> 1e.International shipments ❑Imp'n to U.S. ❑Exert from U,6. "' " PatofWaro rvdb <br /> Transporter signature(for exports only): Date leafing U.S.: <br /> ce 17.TransporterAWLW!d mem ofReWD,of Materials <br /> Transportert nledlfypad a Slgnepre Month 0ey Year <br /> g 1 <br /> Transporter hRladipfyped Name Signal Month Day ear <br /> F <br /> 10.Discrepancy <br /> r 18a.D1svaperxaylokralmn Spm OpaOgH . .. ~.. .... ❑TY ❑Residue ... .. <br /> pe ❑partial RBJeCtldn ❑Full Rejection <br /> Mamdest Reference Number; <br /> 180.Alternate Faculty,(or Geaafal0f) U.S.EPA ID Number <br /> Z3 <br /> U <br /> LL Fadsy's Phone; <br /> aW 160.Signature of Alternate Facility(or Generator) Month Day Year <br /> 2 <br /> 19.Hazardous Waste Report Management Method Codes(Le..codes far hazardous waste own ent,disposal,and meyeing systerns) <br /> 1. 1 H141 z 3. a. <br /> 20,Designated I`oqW Owner or Operator:CaNfl®don of reoelpl of haramaus marvels covered by the manlfeal exceptes Med In Ilam 1 <br /> PmWdrrype Signature _ Monet Day Year <br /> ✓C-521 St`s -� ( 6 <br /> EPA Form 8 0o-22(Rev,3-05) Previous edllwns are obsolete. DESIGNATED FACILFTYTO GENERATOR <br /> LJ0000�39 [) 3) a1 <br />