Laserfiche WebLink
0 <br />t.. <br />.a7-185-01 <br />4� <br />ase print or type. (Fomn designed for use on elite lowbr.) <br />UNIFORM HAZARDOUS 1. Generator ID Number Z. Page 10 <br />[)r T 04S q_60 - GO 4,5 <br />Form ADoroved. OMB No. 2050-0039 <br />EPA Form 87W22 (Rev. 3-�) bons are obsolete. DESIGNATED FACILITY TO GENERATOR STATE (IF REQUIRED) <br />1)01,87664 2) 1 ) 4 <br />1)200164210/40252285 -L) -zQ01CyzI0 7W %10353.183 <br />, <br />I <br />CADgtiW253 <br />Response Phone <br />4. Man" T ho Nurnber <br />I 4310- SKS <br />WASTE MANIFEST <br />.0 <br />. <br />5. Generators Name and Mailing Address Generators Site Address (d diflerent than mailing address) <br />SEARS A/C 06791 <br />5110 PACIFIC AVE <br />STOCKTON CA 952-01 6350 <br />Generatoesftns:, 209-477-8111 <br />6.T rt 1 Com Name <br />0 W-KENN SYSTEMS, INC. <br />ari <br />U.S. EPA ID Number <br />TXR000050930 <br />7. Transporter 2 Company Name <br />U.S. EPA ID Number <br />8. Designated Facility Name and Site Address US ECOLOGY NEVADA 050505 <br />U.S.- EPA I.D Number <br />11MILES S. HHY 95 <br />BEATTY NV 89003 <br />775-553-2203 <br />NW330010000 <br />Facility's Phone: <br />gs. <br />9b. U.S. DOT Des*6 (including Proper Shipping Name, Hazard Class, ID Number, <br />10. Containers <br />11. Total <br />12. Unit <br />13. Waste Coles <br />NO. <br />Type <br />HIM <br />and Paddng &0UP (d any)) <br />Quantity <br />WtJW. <br />I.NON RCRA HAZARDOUS WASTE SOLID <br />D14 <br />P <br />.352 <br />o <br />(ABSORBENT AND OIL) <br />UJI <br />2. OCX-4 4AZAA AVVX tit We 40LI 93 <br />L/00 <br />3. <br />4. <br />14, §;-dal Handling Instructions and Additional Information SK TRCK#109333666 0000370430 <br />SK AUTHORIZED TO RETAIN LICENSED SUBS19MENT CARRIERS AS NECESSARX <br />15. GENERATOWSIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and a=rately described above by the proper shipping name, and are caste, padtaged, <br />. <br />marked and lebeled/placarded, sall are in all respects in proper condition for transport according to apprabie internationali and national governmental regulations. If export shipment and I am the Primary <br />Exporter, I certify that the contents of this consignment conform to the terms of the attached EPAAdmowledgment of Consent. <br />Icertify that the waste minimization statement identified in 40 CFR 262.27(a) (K I am a large quantity generator) or (b) (91 am a small quantity generator) is true. <br />Generator's101feror' d Name Signature <br />AA <br />Month Day Year. <br />y <br />pp <br />IVI <br />16. International Shipments! <br />. 1 1. - . 1:1 Import to U.S. El Export from U.S. Pod of entry/exit <br />T�nsporjer signr4kre (for exports -Ift Date leaving U.S.: <br />17. TransporterAcloriiWledig , n ReeW of Materials <br />12 <br />Signature <br />Month Day. Yew <br />TranSPODrtntedIT 0& <br />. amino. <br />�231 0:3 lot <br />-porter <br />QTrans <br />2 Printed/Typed Nam I S <br />Month Day Year <br />118. Discrepancy <br />lea. Discrepancy Indication Space owfity E]Type F1 Residue <br />0 Partial Rejection' <br />0 Full Rejection <br />Manifest Reference Number <br />118b. Alternate Facility (or Generator) <br />U.S. EPA ID Number <br />Facilitys Phone: <br />W_.. <br />18c. Signature R Alternate Facility (or Generator) <br />Month Day Year, <br />19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) <br />LU <br />1. <br />2. 7T. <br />4. <br />.11 <br />20. Designated Facility Owner or Operator. Certification of receipt of hazardous materials covered by the manifest except as riled in item 18a <br />l <br />L <br />PfinWyped NyheSig <br />moo - year-. <br />4 .4 <br />&4 10*"fJ <br />1 <br />- <br />EPA Form 87W22 (Rev. 3-�) bons are obsolete. DESIGNATED FACILITY TO GENERATOR STATE (IF REQUIRED) <br />1)01,87664 2) 1 ) 4 <br />1)200164210/40252285 -L) -zQ01CyzI0 7W %10353.183 <br />, <br />I <br />