Laserfiche WebLink
02712/2016 FRI 14: 06 FAX ®004/044 <br /> SOL, SK 3HIP0 219_80Y592 ��(�� VIIIIII>ill llll��llllllllllllllllll <br /> i DI) 41..) 195 :325K5 <br /> Please print or type. Form deal ned for use on ante 12 I1d t swfker. Form A roved.0108 No.20500039 <br /> UNIFORM HAZARDOUS I 1 oansWor ID Number CAUl036#h3 2,Pg1 101 E' � eY $ <br /> WA)STE MANIFEST o`n r � <br /> 8 2 SKS <br /> 6. ?rnalro.r� me enyW eereOe$Ie <br /> an Piling Address(if dMerenl i An MaIlIng ee rsee <br /> ) <br /> 2p72 Loomis �d <br /> a CA ,95205-0010 <br /> � Ganarelur P e: 209-946-0674 <br /> e'lde�' re gY51•CMIi, INC. U.S. umber TXROOOOOIZ05 <br /> 7.Trenaporler Z CornDeny ams UtTEPA ID Number <br /> a.Deslgoam FacII,lyNamo and tita Grego S I• — . ' CAL T FUR I, r INC. U.S.EPA ID Number <br /> l 6980 9MITH AVE. <br /> n, NF'WARK CA 74560 CAUg8UE1f37A1f1 <br /> �.to•�7�5•-4n00 <br /> Facllli s Phone; <br /> 1 ga, 9b.U.G.DOT DescApilon(Including Proper Shippino Nems,Hi¢eM Claes,ID Number, 10.Conlalnere 11.Told 12,Unit 11 Waste Codes <br /> KM and Packing Group(1I any)) No. Type Quangly WI.Nm, <br /> 1. NON RCRA HAZARDOUS WASTE,LTOMIly 7_.r a 133 _ <br /> ETHYLENE ULYLOL SOLU71ON (LESS THAN SOYA <br /> 2 � i <br /> 13 LU U <br /> ca <br /> I <br /> L.7C.,rTUr'tr?T I-AIT <br /> C <br /> I <br /> la, pec en ng nslruo m and kelilonelnorm011on '2277 <br /> E4 HR EMERILIEKY N 000-•4613-176O(SAFETY—KL.EEN) <br /> 9K AUTHARTZED TO RETAIN LICENSED S3UfiSEGOEN'f CARRIE'RE AS NECESSARY <br /> 19 GENE RATOR191OFFFROR'd CERTIFICATION:eche hereby <br /> oeCiam that h c IranelsOOfrt icGo�nAlgo eppllVea.0.i,jlnla A acca elndy otlona gMemmeMa06 d gboyo by hre9ro�onelf a po�hlPrnenl and I A nd are mhe Prlmp�eJ, <br /> marked and labeled/placarded,end ere In sg resp p po p <br /> Gpaier,I oarllry that the canlenlo of We conilgnmenl conform to the terms 01 the attached EPAAcknowledgmenl neem, U snare <br /> I Ce tlfy that IBA waffle ntlrllmlZallon alalamenl IdenllMed In 40 CFR 282,27(0)(I1 I am a lefge queMiry goner Or I om e m Y g 0 u I Dey Year <br /> Generam Olterors PgiedRypod ame r h <br /> � cv <br /> M. mane np pnw s Impo l la U 3. ❑Erpoll m U.S. Part or envylaell. _ <br /> DHe leaving U 9.: <br /> 7renaporler elgnalure(fur a>t aria only). <br /> 17.Transporter"novdedgmen(olReoeipl ofMaledate Monln AY er <br /> Slpnalurs <br /> Transport n e p4d Name � <br /> y Mont Day Year <br /> L renepodar 2 Pf Me a erne 9lgneu,re <br /> Q <br /> 10,Worepency ❑a Full Role0on Residue ❑Periled Relecllon <br /> 1U.Discrepancy Indleallon Space Q„andty ❑Type <br /> III MenikelRefarspzq Ntnnu U 5 EPA 10 Numbe< <br /> ` � tt1b.Alternate Fa01111y(or Oeneretar} <br /> Month 1—yYeai <br /> Fad111 a Phone; <br /> 1 0. gne urs rn..Fec ly kNr enermcf) <br /> 10.Haierdoue Waslo Report,Management Moihad Codes(la„codec to hazardous waste treelmenl,dhpoeal,.aM recycling systema) 1 4 <br /> t-f lq1 2 <br /> s. <br /> 20 Deelgnatad FeWllty O nor or Operelvr.CerUAral on of fecelpl d helardoue meledeb severed by the manllul BACepI ea nded In Ilam 1 Be o p eat <br /> ne Qnn pe ems <br /> BpF7nQ �p WESIGNATCD FAC ITYTO DE571NATION sl ATE(IF REQUIRED) <br /> E S"7� r F45-1 -05) Previous adillons are Obeolele. <br />