Laserfiche WebLink
i <br />' ".ase Iran! 01 IYlle. (Form lesioned far use an clap 119 <br />I +Q� 0 141Y43. ) 4) DESIGNATED FACILITY TO GENERATOR STATE (IF REQUIRED) <br />___.-. Form Approved. OMB No. 2050.0030 <br />UNIFORM HAZARDOUS I Genesa1o, 10 Nunther 2. Pngold lEmttgenq gesparso Plane 9. Manlhsl Tracking Number <br />'00981_ 515900 g <br />WASTE. MANIFEST <br />SKS <br />lil�dc�nipP,' tIP' Ir1onrMi Genoralpls Shemoress a, diliflaw Ulan mating address) <br />E HWY lu <br />YPOFN IA <br />31,!, PP9'In. - <br />_ <br />1i.1Fli'xt.' a f as <br />-r'':1INC. U. S. EPA ID Number <br />114�Jr8's _0 <br />Ireunmmr]ConTmny Name <br />U.S. EPA ID Number <br />b. Uesgna:en Po[iAli Namn aro Sae Andras, SAFETY—KLEEN SYETEHS, UNC. 000760 u.e. EPA 1D Number <br />6000 98TH STREET <br />SACRAMENTO CA 95828 <br />916 -•?36-4y13 <br />0 <br />Frit, tl"s I'Il¢ne: GA@09L`E95i7 <br />p.I <br />gb US DOTDnscrplan WAY Pamir SNpoNO III.Hozmd Class. ID Nsmbec <br />1D. Conditions <br />"s <br />e'N Pochirxr Groupe enyb <br />11. Total <br />OumMly <br />12 Unh <br />WLNoI. <br />13. Waste Codes <br />No. <br />Type <br />NDN—RCP.A HA`AP.DDU5 tAASTE. LIQ ID <br />DM <br />o <br />(AQUEOUS IMMERSION CLEANER? <br />DC <br />14DN—A.CRA INAIAt( UUUS WASTE, LIQUID <br />ON <br />(AQUEOUS PARTS WASHER SOLUTION? <br />G <br />139 I <br />3 <br />60 <br />4 <br />a. I <br />14. snenal Afnndlinp las Umeend Adtliauraudmr ' Sk TRCb 0210579 0038191630 0000371455 0904 25 <br />SK. AUTHOAI�EO TD RETAIN LICENSED SUBSEQUENT CARRIER A5 NECESSARY <br />15. GENERATOR'SIOFFERDq'S CERTffICATION: IhambydIsIB Nd la malaria at this amN omenlere rue andacmalel desulhed above IM prop ers t <br />marked andlebeledlplarad°d, and are In nam ns In g y I by D P hipping name, errl ale dessENd parka0ad, <br />sp¢ gopermMlgon in, ;r <br />aPWlcabla inlemmgrWend nalfarsalgovommenWl regulations, Il export sNpnenl and l am w Primary <br />LYPoner.Icerbh'oMthemnlenlsolthbwnsignmonlwnlmmiDUrewmsuftheallxched EPAAehnou@dgm lofConsent. <br />Iuvlll anal IM vasm Mnprization slalemam Wentiraw in 40 CFR 262 (if l ama lorgequamAy gmeaI(b) fill an-mq 'ry goureto0 Is true. <br />ruI.aa4011°yfs Prim°dzlrged Name 5 nolum <br />ManN° <br />Day131nIx:n:uc:M <br />Slupm ns <br />ingpn 1p U.S. ❑Ezpml6om <br />...r U.s. Pon al en /exlC <br />— lansponm sA3nalure (tor expgla aHyl: <br />� t1 7arlsporNr ACAnmHed Dale l¢avvg U.S.: <br />ynem d Bernier d Ala leria @ <br />0 T r1 PrWetlRyped Namo-s� Slgmlu <br />a <br />m ((}}�`�� Mo Da To <br />' <br />Transporter 2 PdnledRypetl akm¢ <br />Signe <br />F Monty Day Ye <br />.y <br />16.0aaeppnry' „ <br />10d. DIECrepanGy Motion Spam D OWnbly Type ❑ResaAm ❑Patio) RejMlan ❑ENI <br />ReIecPon <br />In. Mian le Facbly (or Generator) Manges) R¢Ittmm Nptlbeu <br />� <br />GS. EPA ID Number <br />U <br />LL <br />Far6"SP6Cne: <br />lac. Si car al Allarwle Faulty (ar Genealm) <br />' Month Day Year <br />z <br />wtg <br />Hpzamaax Wa6le Relwn Management Method Codes g.¢. codes loi hazamma nresla Yealmon m <br />A sposaw, end mcyding systems) <br />w <br />T' <br />1. <br />HS44 2' H141 a, 4. <br />1 ZD1 etl Faul Omtto oPttelor. Cin DmU rewgg of lmzardous maleriall mvmodby themanga9 except es ntlotl in trent <br />TV, <br />PAneIYTYPt re sgnaluro <br />p 6donlh qty jyff�C �L° <br />EPA FR,1a p0.22 (tzgvr.U,) P vi rise diI ons are obsglcle L <br />I +Q� 0 141Y43. ) 4) DESIGNATED FACILITY TO GENERATOR STATE (IF REQUIRED) <br />