Laserfiche WebLink
Iter l ug Ue: 43P PARC ENVIRONMENTAL <br /> 559 233 4284 P, 1 <br /> MAR-23-2004 13:58 FROM:CLEAN HARBORS91J' tl-' ���M-`•J <br /> 63730649 TO;ICS PARC <br /> San of Cdifo*r:o--tnWronm►ruol Prot.er;on Age,rcl• P 2�E <br /> Fera Appreved OMB No.20SP 0094IEnpire,s p,30�99f Ste Inst <br /> Pham prlei M iype, Iterm des;On.d for vr•at dire(I?w'kA( p•wrlMr. rTrCriOnS OR IJQe1Ly eo1 P49e 6t <br /> DJ718275 Department of Tp.,c Subsro ca,io urot <br /> UNIFORM HAZARDOUS 1 'tU$EPA 10 No. MoSacramenla.Califn <br /> Uac.nwmt No. 2 Pout 1 Iw{ormaKon.n rhe shaded <br /> 9 dddrew <br /> WASTE (MANIFEST _ Q 7 2 is not real by Federal In,w <br /> 3. G.neraar' t+6rne and Mellln A •� � 1 U a' <br /> >♦s• <br /> 4Eg11 'iit1:C CCit:r�kR!Nano SAM A. San Mon9ni Document IJu nber <br /> n SOCIIA0111r CA 0201 2$364857 <br /> a Gaae,rafor"s phone 1 Z�5 B. StillOen■ratar's Ip <br /> 5 Transports 1 Company Mame <br /> 6. US EPA Id Number C Sara Transpaner'r <br /> d Cleary Harbam Env� `3irnriigt Inc '"f D. Trenlperte,ni+hone �lgpp <br /> 7 Transirerter 2 Caerpaey Name <br /> �yy�(( ll B. US EPA t0 Numbs C $lot.TransorMr's pID I��.1 (781)Ddl <br /> �ti i � I I--�L._l I F.Transparyri Phase <br /> 4. c66rated Fi lBy Nam°orKl Via Address IQ US EPA ID Nvasber <br /> D0d Clejo Harbors San,lase LLC l ab Feet ivIs ID <br /> me 1021 9erryessa Road <br /> h2 San dose.CA,85133 I '� H.raai;y.Pian. <br /> 17):g _ 3 1 0 409 451-M <br /> vr,,i 11.l DOT D•serafaion lindWinq Proper Sltippmq water HaYard Cloys,And t0 Nun ls-ij 12.G listrsera 13 lotal 14 Unit <br /> NON RCRA HAZ.AARCDOUS Willi TI=l Na, t 0v011111i m/Vol lotil <br /> F S1aM <br /> 001 77 �� � 1s4 <br /> EPA/ e,r <br /> QN b — <br /> w E wig <br /> 4 R !►A/lD h■r <br /> A <br /> r e <br /> R <br /> ad lPAlOrher <br /> Z � � Slots <br /> U <br /> LUin <br /> EPAfOMrer <br /> J,tvd�l htstal i7aaf s hx 141aFwSOI�Wiwi A(Fp K Handling Cedes far Wowl kilted Above <br /> a. b. <br /> N <br /> W <br /> c. d. <br /> l s. sp.od Haed4nq Iastrvcf pn7 p■d Addiiionvl l.~r6rmatton 34 HOU—k—EMIEW ENCY 9 (800)483.3716 <br /> )Al Pn*w PPE V*wn hlartdlirtg vralste i ia:CH2232210 <br /> z <br /> 16. 04iftATOR•f CiRtNICATION. i fmby dectl that rhe,tamest:of His eare;jI ment are Wily and accuroM described abo•e by proper shi ng name and ore ClOtii(iad,poca•d, <br /> and ed,and loFtel.d,and aM In dl rope a <br /> prQpNWndition for hats rl6 hi 6&o d' f�Po Y 9 y(KEar mgaapplicobk Tniem01il l and national gpvernmem r•gvhat:oluit I an o lap.Ell g—alrsr,f a°rfi(y iI hove a pray wa in Ill to reduce Me,oelu■tsl and lapl of waste ge•erplad to she Isle f hot°danrmined to be°conpnsic lly <br /> praciaabl.end shat r f e,se,lacnd 11—fipractidable.I'll of treatment,sfosage,of dilpasol curwily avalloble lone wAuek mini ril the presel cad toll ihraat a hvmon"IN <br /> all and Nr•en+Ironelewl;OR,If I am a:opal gue ry y sista rot,14—mad.a till faith.ifam to mlelmlz my mo.ge,rrerorian oad wM IN,b•r1 wp.4 martrsg•me.i method IitW is <br /> to wal•ble,to me and ill 1 can affaysl. <br /> 'Y F inled/Typ• Sio.4Wrc <br /> Month Day Year <br /> z _ s fi.� r F s� ss <br /> 17.Yran .11 AAcus <br /> knv..wd em of Recwi a of Motorial: <br /> Uj ►rinnd/Type+, / O � SigrtaN `\ Month pp Year <br /> i 3 z • / y ® �{ <br /> 118. TtOMPOMW A4knnwLd of al Real I of Mobrial t <br /> Prtnted/Typad Nrmse, iign°Ivr. Month Ray rbr <br /> !N <br /> V B _— <br /> t4. O;swlsireltry Indication 5poa <br /> Z- A <br /> C <br /> I <br /> L _ <br /> 1 2D_Fod r Own w O kr CeAIilCetion e(r i of hoxordaas moterids redhij No $1µCe t as rived in IMM I <br /> T Printad/T Name �J I� ` <br /> � lf- I fff/���i— Mnnth Doy Yater <br /> Y <br /> r 0 e) t5 1,411 <br /> DO NOT WRITE BELOW THIS UNE. <br /> DSc 6022A 1119191 White: tSOf SENDS THIS COPY TO DTSC WITHIN 30 DAYS <br /> 0A B1oa-22 To P 0 001,3000.50410monto. CA 9581,.1 <br />