Laserfiche WebLink
Please print or ry Form deal ned for use on elite 12 dcll fIntioemanter.) from .OURI <br /> UNIFORM HAZARDOUS 1.Genareb 10 Number 2,Page 1 d 3.Emergency Response Phone 7007120931 man" JJ.,,. <br /> WASTE MANIFEST C A D 9 8 2 3 5 6 9 4 1 1 00 4249300 1 <br /> 6.Cewra4Xe Nems and MV AIlla" Ga M"SRa Addteas(gdffl a tNwn UgaddiM) <br /> NCA CRANE NPORKS <br /> PO BOX999 2373 N14RIPOSA ROAD <br /> LA PORTE TX 77672 STOCKTON CA 96206 <br /> Geireremre Phone: 209 464-7635 <br /> S.Transporter 1 Comperry Nano U.S.EPA ID Number <br /> ASBURY ENVIRONNENTAL SERVICES C A D 0 2 8 2 7 7 0 3 6 <br /> 7.Tmeparber 2 Company Nemo U.S.EPA 10 Number <br /> 9. rod TaligName and SRe Acidness U.S.EPA ID Numbs <br /> CHEMCAL WASTE M'1NAOENENT <br /> 35251 OLD SKYLINE RD <br /> KETTLENAN CITY CA 9VN C A T 0 0 0 6 4 6 1 1 7 <br /> Fadi' sPhaa: (559)386-9711 - <br /> 9a. <br /> go.U.S.00T Deaalptlon(arWdtnB Proper SHppinp Narre,Hazard Class,ID Number, 10.C 11.Total 12.Unit 13.Wash Cada <br /> HM ad Peddrg Grow(danY)) No, Type Ouarbty WLNd. <br /> 1. l112 <br /> NON-RCRA HAZARDOUS WASTE,SOLID (OILY SOLIDS) D M Dr7/ P <br /> zW 2. <br /> LD <br /> 3. <br /> 4 <br /> i <br /> 14. Irdormation <br /> NAERG#9B1 : 171'PROFILE 09BI MSS 7 OILY SOLIDS'PO#A11011BB81'APPROPRIATE PERSONAL <br /> PROTECTIVE EQUIP&ENT <br /> SG / N1146774 y'e� [/ ��(✓— ���f��� <br /> 15. GENERATORStOFFERORS CERTIFICATION: I hereby declare BW the content&of INS cond9 nonl are fU4 andarMaeWY decibed above by the proper WppbB name,and are dassifed.pakagad. <br /> marked ana labeledrplararded,and ere in all respells In pope co droon for transport according to applicable trimmed"and national govammentel regwatiaa.g eWa1 shipment and I am fin'Arwry <br /> Exporter,I cB"dW the contents of this oonsigrena tconform to the oma of the atbd*EPA Admowledgnent of Consent <br /> I tardy tat the rash mLemtratian etatemerd Mendfied hog CFR 262.27(x)id I am a large quantly generator)or(b)(dl am a small quantity 98nemba)Is ave. <br /> Gene rdORaors Pdn Name Sign Mmm Day Year <br /> V l l0 <br /> 16.Infannobial SNpmems 1-1 Iraqortto US. ❑Elart Rom U.S. Ponufentry/ext <br /> I � Transposer algnaava(for exports ordyj: Oat&leavag U.S: <br /> 0: 17.Traspo?rAdmow64manlo1Recoiplof Ma"s <br /> i Trenaperbr 1 PnnledRyped Name SiB M1bM 0 Yae- <br /> Transporter 2 PnmedlTyped N l bVvalm Month 09y year <br /> t18.Dkaepercy <br /> t 18a.Disuapancy lndkarer Space ❑ chantity ❑Type ❑Residue ❑Pada)Rejaw+ ❑iuY Rejxtin <br /> Manliest Reference Number. <br /> 181,Ntamele Facility(or Genembr) U.S.EPAID Number <br /> I V <br /> Fedl9yy Piwre: <br /> 18t.Signabue of Allerawte Fealty(a Ganere,r) Maim Day ser <br /> 19.Hazardous Were Report Management Method Codes(Le.,codes for hazardous man,treapnenl,dl and recyding systems) <br /> 2: 3. 4. <br /> Miry Operator:Cesdrulbndrewlpt of hazardous materiels wvered by n a9 Madh lbm 78e <br /> V S re <br /> ori' _ 9D 22(Rev.105) Previous editions are abadete. DESIO ATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br /> i <br />