Laserfiche WebLink
t[.......r—t..—A Fnr <br />zea m AthaIII* .h% runa"tar I <br />Form Atwroved. OMS Ne_ 2050.11039 <br />naaoc <br />EPA <br />Mu... w .r rte• r _.... ^-'�--- <br />UNIFORM HATARDOtIS <br />--- - - <br />1. Gerwalor <br />11 <br />2. Pam ! of <br />3. ! Phone <br />924-esoa <br />A Manliest Tracking Number <br />004701125 FLE <br />WASTE MANIFEST <br />CAL 0 0 0 <br />3 5 7 4 9 7 <br />�eoo, <br />5. Generatods Name end Mabing Address C <br />VS MQ08 Generator's Sde Address (Ndifferem than marling address) <br />885 West 11th Street <br />racy, CA 95378 <br />Gemeratods <br />renspoter Name <br />�n <br />�PA NU 0 O 1 <br />1 0 9 2 4 <br />Stericyde Specialty Waste Soluti <br />s Inc <br />7. Transporter 2 Company Name <br />U.S. EPA ID Nudes <br />C A D 9 8 2 4 <br />9 2 3 9 9 <br />411 Chemical Disposal Inc <br />77D—e4nad FW Name and SW Address <br />ter! cycle I no. <br />U.S. EPA ID Number <br />70 ExecuUve Drive <br />nd)anapolis, IN 48241 <br />I N R 0 0 0 1 <br />1 0 1 9 7 <br />FadW& Phone: <br />ga. <br />I 9b. U.S. o0T Description rmduc g Proper S' <br />Name. Hazard Class, ID Number. <br />10. Containers <br />11. Total <br />12, Urdt <br />1 & Waste Codes <br />No. <br />Type <br />HM <br />and � (deny)) <br />Otran ay <br />W1Nd. <br />® <br />1' Non RCRA hazardous waste, <br />uid <br />13 <br />041 <br />CR <br />30028 <br />P <br />2' Non RCRA hazardous waste, solid <br />311 <br />001 <br />CF <br />D 0012 <br />P <br />3. <br />4. <br />_ <br />14. SpedW Hanfrmg Inslnwtione and Additional Vdbrm <br />1.5(1404-CVS(State Reaulated UcM <br />-CA) 1887112 <br />2.50404-CVS(Sto ReaulaIed Solids�- CA) <br />15. GENERATOWS10FFEROR S CERI*MrATIWE I hireby declare 9A the contorts of 8ris conelgnnent are krby and accurately described above by tite proper suing name. and are classi W. packaged, <br />marked and labeled/placarded, and aro in ad <br />la proper condition for transport acconfrV to applicable intern rtialat and nallonal g reg laliow ti export stipment and I am the Primary <br />Euportm, I c8*that thecort" of fhis <br />t rznfam to lira of tic art d EPAAclumWedgment of C=ft <br />I artily brat the waste rmirirr�ation statement . <br />In 40 CFR 262.27(a) (d i ran a large quay* or (b) (d I am a Wd quantity generator) is bue. <br />GenerskRYMWS PrintedfTyped Name <br />Mau Y em <br />�I.-( <br />4>�Oflje <br />D <br />7 127 1 1 <br />� <br />�7 <br />16. lnternalanal Shipm,elds 1J tmport to <br />❑ Evm ton U.S. Port of"We&. <br />Z <br />T tare for exports onn: <br />Dale liuoinq U.S.: <br />Or <br />17. Traqo;IerAdmwA9dpW of Recut of Maleriats <br />NMarlo <br />ra'porter 1 ftkffyped Nam <br />us Howard <br />s9natuire/Month <br />G-- —.1 <br />Vay Year <br />7 127 ill <br />Trogorto 2 PMWWW Name <br />16. Disaeparlcy <br />18a. Discrepancy Indication Space ❑ <br />❑ Type ❑ Residue <br />Manifest Rebmnoe Number. <br />❑ Partial Rejection <br />❑ Full Rejection <br />18b. Alternate FacTity (or Genera" <br />U.S. EPA ID Number <br />_J <br />Feo3 s Pluton: <br />tu <br />18c. Sole- WAllantats Facility (o Generator) <br />Mont �Y Year <br />� <br />y19. <br />Hazardous Waste Report Management Method Coder,(ke., codes Ior tazaldors wafts beatmestt. disposal. and mcy by systems) <br />® <br />f. <br />12, ( <br />3..- <br />4. <br />2D Desgialed Facility Owner or Operator. Cartkaten cepoeipt of hazardous mates cm ed by to mardest qpept�ss raw in Item <br />PrintedIffned Nam <br />MtDy year <br />acc rl <br />Vo' <br />Ob la1a <br />Form 0700-22 (Rev. 305Previous etf(tions are obsolete. �' 0' pES)GM f M TO OFA4 STAFt a REQt� <br />f niffir"a At 1 a.rrLZYst7 erra�aS to a0226ZQ: <br />