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_ 8K 9141P#203024844
<br />CSG
<br />a4 HR EMERGENCY #1—Sail-466-1760 (SAFETY—KLEE'N -- CIMRACT #941,3e)
<br />15. GENERATOR'SOFFEROR'S CgRTIFIGA710N! I homby declare that the t ontents of th18 contnmont Ora i dly and tmalr$41y, dosonbad above by the proporshlpphg n nmo, And AM clessilled, pRftgod,
<br />marked OW IaheledfplacArclaf, art are in alt respente in proper oorgHtion, fa tr. sport according to APPI10ble, Inteinatlonnl ,-0 national governmental M0011ons. If export Shonnenl and I am the PrImary
<br />Exportor, I carlify thatthe conte11%of this consignment conform to the terms of Iho attached EPAAekngwledgment'of Comfifl,
<br />I certify that the waste m1ru mizaboq statement MentiNx In 46 CFR 262.27(0) (if I ama targe quRmIy genera�trm or'(b) Of 18m a small rranefy genoratot) I$ troo.
<br />narA a sfr�tleror's 1+rkntoo yp ama a aY
<br />J tfi, Interne onalshlpmoMs
<br />1-11 Import to U.S, t _J Export (ran U.S. Pat of 00710x*
<br />Transporter SIn•nllsc foexports a1l parrmmrn (J.5
<br />17. TrmsporterAckrrnnledgniml of Receipt of MRWOIG
<br />E. TranSYpnor I Pdrser9Typrtl Nadu g teture 1-- monill Day
<br />� f � 4"...C?.• �/ / ,t.,y rte,, .- .,r.� .�' �”' al
<br />Trnnspr)rrer 2 Pnntedrtyped Name51171
<br />b pistons Month Day
<br />a
<br />98. D rn pansy p �-
<br />188. Dlswepancy Indlcetlon $oicc Ouantiy Typo F"Id, Partal R04ctlon 77
<br />FtAI Rejectiot
<br />fv*IfastReference mbw.
<br />10b. Altemelc facility (or Genamto) U.S. EPA ID Number
<br />U
<br />U< Facility's Phona;
<br />lk 51gnRntm ofAltemate Fncihiy (o GeneratOrj Month Day
<br />5
<br />til, Hazmfdous Whale Report MmaprAant Methal Cod%(Le., coft for hazardous waste treatment, tllsposol, and reayding sy(Aoms)
<br />LU
<br />21). d Fx
<br />gotT atetGy
<br />PrintecllTOwneror Opemlor. CerURcstion of rocelpt of nAznrdoua materiAlR cOvarad by the manifest except noted in Item i8a
<br />yp SIttron mr
<br />� Month ey Y
<br />TA' Form I056t 12r�s� 2 Rev, 3.05) Previous edirons
<br />1; 4�d0@56 a oDsolgla, DESIGNAT50 FACIUTYTO DESTINATION STATE (IF REQUIF
<br />1
<br />08/22/2012
<br />09:15 209545 80
<br />SAFETY KLEEN
<br />PAGE 03/08
<br />7l 4r^.
<br />!'1
<br />Pleaae print or type. (Form desf4rtad for use on elite 12•pltch) typewriter.
<br />form Approved. OMS No. 20504039
<br />UNIFORM HAZARDOUS 1. Gonerator ID Number
<br />2. P C 1 M
<br />a Emerenry Rasp Phone
<br />1-'8 0-46-1760
<br />4. Mantrot rac mg Number
<br />WASTE MANIFEST C�A!3 �'C ect ?,5-5
<br />n C
<br />b. Upora(or's Name and Mailing Address
<br />enarws She ries Q(tlIBOPortI ItUm mrifpnp address)
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<br />t f��.,. �� �.<<5;.e AV -e
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<br />Gahafatof 5 Pf10na;
<br />frotslpnrinr100-
<br />ro p� Name
<br />Sf3FETY •Ki��A JYSTCMS, INC„
<br />U„BPA ID Number
<br />TXROOSe50930
<br />7. Transporter z cn,mon” Name
<br />U.S. fePA ID Number
<br />8. UesignaUd Faclllry Name and 6he Address US ECOLOGY NEVADA
<br />� �ID Number
<br />11 iMILES S Lr- BEATTY HWY 95
<br />BEATTY
<br />, NY 89003
<br />1300-239-3943
<br />F'acifit '$ Phone:
<br />Nte<T3.3001 �+0rr30
<br />9„.
<br />9h, U,6. DOT Daacnption (mdud'mg Proper Slipping Name, Hazam Class, ID Number,
<br />i0, COW teri
<br />11. Total
<br />12, Unit
<br />HM
<br />arld Packing Group (s arry))
<br />No.
<br />Typo
<br />t�nrsrttlty
<br />yy(lyol.
<br />13. WRA10 codas
<br />+
<br />i WGt MCRA HAZARDOUS WASTE SOLID
<br />DM
<br />P--
<br />a
<br />(ABSORBENT AND OIL)
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<br />T2.
<br />_ 8K 9141P#203024844
<br />CSG
<br />a4 HR EMERGENCY #1—Sail-466-1760 (SAFETY—KLEE'N -- CIMRACT #941,3e)
<br />15. GENERATOR'SOFFEROR'S CgRTIFIGA710N! I homby declare that the t ontents of th18 contnmont Ora i dly and tmalr$41y, dosonbad above by the proporshlpphg n nmo, And AM clessilled, pRftgod,
<br />marked OW IaheledfplacArclaf, art are in alt respente in proper oorgHtion, fa tr. sport according to APPI10ble, Inteinatlonnl ,-0 national governmental M0011ons. If export Shonnenl and I am the PrImary
<br />Exportor, I carlify thatthe conte11%of this consignment conform to the terms of Iho attached EPAAekngwledgment'of Comfifl,
<br />I certify that the waste m1ru mizaboq statement MentiNx In 46 CFR 262.27(0) (if I ama targe quRmIy genera�trm or'(b) Of 18m a small rranefy genoratot) I$ troo.
<br />narA a sfr�tleror's 1+rkntoo yp ama a aY
<br />J tfi, Interne onalshlpmoMs
<br />1-11 Import to U.S, t _J Export (ran U.S. Pat of 00710x*
<br />Transporter SIn•nllsc foexports a1l parrmmrn (J.5
<br />17. TrmsporterAckrrnnledgniml of Receipt of MRWOIG
<br />E. TranSYpnor I Pdrser9Typrtl Nadu g teture 1-- monill Day
<br />� f � 4"...C?.• �/ / ,t.,y rte,, .- .,r.� .�' �”' al
<br />Trnnspr)rrer 2 Pnntedrtyped Name51171
<br />b pistons Month Day
<br />a
<br />98. D rn pansy p �-
<br />188. Dlswepancy Indlcetlon $oicc Ouantiy Typo F"Id, Partal R04ctlon 77
<br />FtAI Rejectiot
<br />fv*IfastReference mbw.
<br />10b. Altemelc facility (or Genamto) U.S. EPA ID Number
<br />U
<br />U< Facility's Phona;
<br />lk 51gnRntm ofAltemate Fncihiy (o GeneratOrj Month Day
<br />5
<br />til, Hazmfdous Whale Report MmaprAant Methal Cod%(Le., coft for hazardous waste treatment, tllsposol, and reayding sy(Aoms)
<br />LU
<br />21). d Fx
<br />gotT atetGy
<br />PrintecllTOwneror Opemlor. CerURcstion of rocelpt of nAznrdoua materiAlR cOvarad by the manifest except noted in Item i8a
<br />yp SIttron mr
<br />� Month ey Y
<br />TA' Form I056t 12r�s� 2 Rev, 3.05) Previous edirons
<br />1; 4�d0@56 a oDsolgla, DESIGNAT50 FACIUTYTO DESTINATION STATE (IF REQUIF
<br />
|