Laserfiche WebLink
3927 East Clark Drive PR0514138 <br /> October 10, 2019 Program: HW <br /> PHOTO 2: Rock & oily absorbent disposed of as non-hazardous waste. <br /> NON-HAZARDOUS 1.Generator 10 Number 2.Page I of 3.Emergency Response Phone 4.Waste Tracking Nember <br /> WASTE MANIFEST a 42 `1-304 `el4+'1l; t+RA° <br /> rr <br /> 5.G r.n.Io's <br /> .Generalo's Name..Mailing Add.. Generators Site Address(e different than mailing address] <br /> YA4ak b S.1aly «F.4xtf.`+, Agvl 71,11 .3,10a <br /> IYI'7 P.,S,erF U�.tes sil;�v:ktcan, f5L 4!.245 <br /> Gaoe"Jil nlrre-9 <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> 6xueAAea4w IIo.a,r.•,.y 13'�¢eroe Zncr <br /> T.Trenspoder 2 Company Name U.S.EPA 10 Number <br /> 8.Dii-91 y Facility Name and Site Address U.S.EPA ID Number <br /> R"-t-1s�11Jk !WM Jtl2.Yr "3i.-Ff YefS 1..:.'. <br /> 23811 F,rr_ IU.4 <br /> �.va, c2 91760 <br /> Faar'e Pkone: 904.9,13.,A 1 r"+0 <br /> e` v a, <br /> 9.Waste Shipping Name and Description 10,Containers 11.Total 12.Unit <br /> No, Type Ouandiy WI Nal. <br /> ¢ 1.Mcw-6issnralnn.r 7S;eptR !!c>d.xtl 9C-w_� ; n! 01;iy <br /> it, r r <br /> � z <br /> 3 <br /> 4 <br /> 13 Spepal Handling Instrrrtime and AdtlPoenal Information <br /> 1) AMA, 17 41, <br /> 424-#Oa >,aldez j1'..WWV1a w 5z'iCfsti�y g�.eS• eneoe4avt„ry umc.rk,r cep r- fS6Y) <br /> 1 <br /> HY`rO5E,54r'D6 f Kid` <br /> 14.GENERATORSAOIF'FERORISbel"d Namemed CERTIPICATION:I hereby e�clare that the contends of this consignment are f II <br /> marXed am labeled=Wawreed and are in all respects in pmper conddion forIranspon accortling io applicable Iemaaccurand nationalgWemmenl t regulations. <br /> GeraraiWy0tlerois PnnteN! Yand accurately ationalgabove tnthepropershipping name.and are classlfiy.pa <br /> yped Name tkagad, <br /> -' Signature <br /> -. 15.letemashmal Shipments Month Day YfiY: <br /> 2 ❑Impon to U.S. <br /> Trans nen S nature par ex ria onl ❑Erpod Irpm U.S. <br /> w i6 T2nscod"Acknoxledgmem a Receipt of Materials Pod of oniry/axil' <br /> ¢O T2"speden l PnnM%W0,ped Nae Date.leavin U.S.. <br /> y Signature <br /> Trarspprter2Pnn1¢drtyped Name -^( .' Month <br /> Signature <br /> n.dweparcy - - <br /> 1]a.0iscrepaF4y Irrmcaupn Spade <br /> ❑Duam ry <br /> ❑Type ❑gesltlue <br /> lion <br /> M%c Anernme Fyilrl Partial Ail ElFdx <br /> Y-al <br /> VManlfeel Reference Number, <br /> n` U.S.EPA ID Number <br /> C F",FMre. <br /> �e 17c.S,m,,e d Ahemaxr Fret la <br /> Generalist) <br /> D <br /> 111 D.Waled 1l16 <br /> p'"�hped Ne ne y o n"„r Oi>eraloI Cemlkaldn M re41p1 nl melenale maM <br /> bl'db manllory 9.cap1 u rimy In Mem 17a <br /> 1 GS-RLC-O 5 SlgneWre <br /> 11877(Rev.ePoB) 16rttlf r' <br /> GENERATOR'S/SHIPPER'S <br /> Lydia Baker, REHS Page 2 of 54 <br />