Laserfiche WebLink
Fax Server 8/6/2015 4 : 01 :05 PM PAGE 44/046 Fax Server <br /> HECEIVED <br /> f°T"^'�';',;ie:;:;:::;'�;,hi«:}fA e'.+r toy lq'. U'�,:.G[>.O.�,,4GZ:iaCT.i7gsrfll0,Cn.95�(?-L400v+ftttin 30 Gaye_•• fV�f 1'�T� <br /> Pleas9 prfm'a (Form de9lgned for lsp an aide 12 'ah ` I'm p�me AS�A0.0039 <br /> UNIFORM HAZARDOUS 1'DNrHaIa NN'arher 2Pap1d 3.EneyemyRoywnsa Phwie 4.MM ost M N er ��F- <br /> WASTEMANIFESr tA4 1 .,I.' t-300-424-8 ]0 006MOW <br /> Gen aNvre aqd MeiYw Addw <y.• iyrtr GenemC/s sil.Adtlmla' <br /> i I. ' �fF VrX° �i. ;tf'i✓ 7,/:IC r (dd'flttegl Ugn maEing add!0%s> AL <br /> 1T <br /> I ..- c, YI£ Flt rj F(ILL .- I� .'� �_. {' r. � r � rs r£ � t .t e� !�, <br /> :-�r: .; .7:...y �f ( [: �iFr..� ,.r.a• ; ( E 1,'lc <br /> GenemletsPhpd a' '✓ jr� `J�'.�= — /•� •"2 •� __� C I'. 'i,. r F1 .:aC.u� {:, <br /> 6.Tral i Oampny Name j r U.S.EPA ID Number <br /> CL'c>i3 'Els}`;�IVVIROhA ENT.A! SERVICES CAD982413282 <br /> 7.Tmnaq wler2.Comgpty,Nal09p.:; <br /> • ,�. U.S.EPA ro Number <br /> B.Oesl�alea Face Iamaegp.�apdeyeec EVERGREEN Oto IirC. U.S.FPAID Number <br /> 68ii:i SMITH AVENUE <br /> NEWARK CA 94560 CADOM7418 <br /> F a Phone: 5I0.79rr 400 <br /> 9a, 9b.Ua DOTWsci0tm#nttudbg PmPWftft emA Haloed CIM,ID Nuhn, iO.Caaainaa 11.Toal 12Um1 <br /> HM end Puldng <br /> ecw (dnry)) NO. Type Quantity WVvol. 13.Waste Cedes <br /> 0 1.NON-RCRA HA3'ARDOVS ledAST'E. LIQUID 001 TT <br /> r <br /> m x.; <br /> w 2. <br /> t0 <br /> 3. <br /> 4. <br /> id.Speclm HardRrG Inshucfiww eMAddmmn Imm�oetiwi <br /> PROFILE= iNVOIC6 0 u•`'`' I I G G (6 <br /> ^T E )r 1,71 `!YEAR PROTECTWE CLOTHING SALES ORDER$ <br /> 15. GENERATOR'SIGFFERDRS CERTINGATIOrt Ibewbydnlmlhat Neanantsoflft= g imfulyandaeomdalydasukelzbMbyma PmwsNppi Mmu,ard mcwdm,padaged, <br /> marked and laboledfplaanad,and am In all respects in pmpermrElfion for aarspo"aaording so appFtble otemadadalam national gmmrwm mgWtiwu.11 export shipment and I am Na Pdmmy <br /> FJpodsr,I a"Ty that ft contents of(h1s angmenl cenfomt tithe term of the attached EPAAdmowedgrnerd of consent, <br /> I cwdfy pmt the xaste minlmdlopon saament Identified In 40 CFR282270)("tam a Wipe quabdygereW or(ty)III=a small quandy generator)htrue. - <br /> Genemla's108emrsPrimecyaccl%me - S57mWre. <br /> Mont Day Year <br /> I .. y <br /> J 16.IMamatlonal Shipments <br /> ❑dspod to U.S. ❑Fxpo"Aem US. Patofanbyaxn: <br /> 3 Tmnspalermglahae(arexpan wry): Oeleaevifi9 U.S.: <br /> w 17.TmnspommAdinm efigment of Reodpt of Marek '- <br /> Transpld 1,PdMedFyytsedNme f(j�{{ / J/. 9lgreua / Month Day year <br /> CL <br /> mz <br /> < Tmrapaner2 yped Name $Walk e' Month Day Yen <br /> _ •l <br /> I <br /> 18.Discrepancy a <br /> i8a.D:swepanq lydeation Space ❑Oaandy, ❑Type 1-1 Residue ❑Parpal Rejector ❑Full Rejection <br /> Marsfest Reamna Number. <br /> 18b.AEemale Faddy for Ganmlar) U.S.EPA 10 Nwber <br /> J <br /> V <br /> LL FadNys Plane: <br /> Q 18c.Signatu owtornme FeditylaGenamtorf Month Day zr <br /> 2 <br /> h19.Hazardous Warne Repo"Menagemem Method Cods(l Codesarhammonwame merriment d'aposat and"div systems) <br /> 3. <br /> 1. 2. 4. <br /> 1 20.Demyaad Faalby 0A ror Operda DeMmdon Mreaipohe Mous ma n9sw emd Mae mnBes exap as led in Item lea <br /> n me Signsnm Month un year <br /> EPA Form 8700-22(Rev.345) PreWas editions am obsdele. GENERATOR'S INITIAL COPY <br />