Laserfiche WebLink
9 0 <br />SK SHIP# 220355201 <br />Please print or type (Farm designed for use on elite (12 -pitch) typewriter.) <br />Form Approved. ONE No. 2050-0034 <br />MI NW294984 w <br />GENERArvn 3 "....41- — r <br />UNIFORM HAZARDOUS 1. Generator lD Number CAL280225317 <br />2 pagg l <br />y, ,ot 1i9T ft- Pft <br />4 A, ° r�p�7yPI Q � SKS KS <br />(i [j, E+ <br />WASTE MANIFEST <br />E7 i�V <br />5. ganefatofa Name and %im; Address . Ceneratufs Site Address (if different than mi address) <br />I.0 Or bpof NUrserie5 <br />5400 E Harney Ln <br />STOCKTON CA 95210 <br />r_09-993-0365 <br />GeneaWsPhona. <br />6.T , da �gR�FVff$SYSTEKS, INC. U.S EPA ID Nunber TXRQhal11OB1205 <br />7. Transporter Company Name U.S. SPAM Number <br />s. Designated Facility Name and Site Address CLERN HARBORS BAN JOSE U.SEPA IDNumber <br />1021 BERRYESSA ROAD <br />SAN JOSE , CA 95133 <br />400-441-0962 CRD059494310 <br />FedaNs PIIaw. <br />ga• <br />9b. US. DOT Description (including Proper Shipping Name, Hazard Com, IO Number, <br />I'. Cents <br />11. Total <br />12. Unci <br />10. Waste Codes <br />No. <br />Type <br />HM <br />and PacHng Graup(ilany)) <br />Quantity <br />WINol. <br />X <br />I. NA' y7 HAZARDOUS WR51E SOLID, N.O.S. <br />SHRVIN6S), 3, PG III <br />DF <br />+ r <br />P <br />D005 <br />141 <br />o <br />, (BARIUM, BRAKE <br />itxr <br />i <br />zNaM NON RCRA HAZARDOUS WASTE SOLIDS, <br />WITH OIL), MFA <br />4- <br />DF <br />'= <br />P <br />352 <br />(ABSbABENTS CONTAMINATED <br />r- <br />I <br />.9 <br />s, <br />4 <br />w. Spedal Handling lm=ons andadddimal info Um I S a BJ 7153045N vU 10fi176 <br />1)ERG#171• <br />(SK y TFI) <br />24 HR EME14GENCY #1-800-468-1760 <br />AUTH AS ''AGENT -FOR" BY GEN TO RETAIN LICENSED SUB CARRIERS AS NECESSARY <br />15. GENERATOR'SIOFFEROR'SCERTIFICATION: I hereby desire Mat the contents oflhlscamignmenl am away and accurately described above by the proper shipping name, and are classified, packaged. <br />marked and labele0awded, and am in as respects M propercordition fortranspart acwming to applicable intematiom and national govemmentii regulations. If export shipment and I am the Prmary <br />Exporter, I certify that the contents of this wrisigrmentmakirm M the terms of the attached EPAAcknoMedgment of Consent <br />I cartify that the waste minimization sratementiiemified in 40 CFR 26227(a) (If I am a large quantity generator) or (b) (if I am a small qu achy genemur) Is we <br />GeneaWfs+C6erots PdntedrTyped Name - 6ignaNre Month Day Year <br />�.r <br />F <br />16.Imemational Shipments <br />❑Importb U.S. /PonolenbylexiL.— <br />Z <br />Transporter signifies (for exports only)! Date leaving U.S.. <br />17. TransporterAcknowledgment of Receipt of Materials <br />C <br />Trensponer 1 Pnrdedrtyped Name Signature Month Day Year <br />�2 <br />0 <br />QTransporter <br />2 PdnteWfyped Name Signature MOM Day Year <br />K <br />1e Discrepancy <br />i <br />19a. Discrepancy Indication Space ❑ Quantity ❑ Type ❑ Residue ❑ psmal Rejection ❑ Full Reler,w <br />Manifest Reference Num <br />166. Atemxte Fac1q (or Genami U S. EPA ID Number <br />J <br />U <br />LL <br />w <br />Facilitys Phone: <br />18c. Signature ofAaemate Fadlity(or Generator) 'korm Day Year <br />Q <br />2 <br />H19, <br />Hazardous Waste Repan Management Method Codes fe.. woes brhazardous waste treatment rSsposal, and reryding systems; <br />W <br />O <br />1 2 <br />20. Designabed Facility Owner or Opealor Cerfil of receipt of hazallous materials covered by the manifest except as noted In Item tart <br />1 <br />PrinteWfyped Name Sgnamre twth Day rear <br />nnna <br />MI NW294984 w <br />GENERArvn 3 "....41- — r <br />