COMPLIANCE INFO_2020 - Laserfiche WebLink

Home Browse Search

SSL SK 5H I P# 227664220 �1Il� 11 111111111 11II II Nil 111111 0069531091K4 Please print or type Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page3-Emer enc Response Phone 4.Manifest Tracking Number WASTE MANIFEST CAL000327839 1- 0 -458-1760 006952608 SKS S.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) Les Schwab Tire Center 673 1717 W Charter Way STOCKTON CA 95206-1114 Generators Phone: 805-438-5487 s.Tr SApF TYm LEEN SYSTEMS INC u-s.EPA ID Number TXR000081205 7.Transporter 2 Company Name U.S.EPA ID Number CLEAN HARBORS ENVIRONMENTAL SVC INC. MAD039322250 8.Designated Facility Name and Site Address CLEAN HARBORS EL DORADO, LLC U-S.EPA ID Number 309 AMERICAN CIRCLE EL DORADO , AR 71730 ARD069748192 870—'863-7173 Facility's Phone: ga 9b.U.S DOT Description{including Proper Shipping Name,Hazard Class,iD Number, 10.Containers 11-Total 12.Unit HM and Packing Group(if anyl} No. Type Quantity wt.Nof 13.Waste Codes X 1RO UN1950, WASTE AEROSOLS, (EACH NOT DM �� P D00 D005 D006 o EREEDING 1 L CAPACITY), 2. 1 (DO81) W D00 D10108 331 Z 2. W c� 3. I 4. 14.Special Handling Instructions and Additional Information TSD:EL 79118606 LE 15361 CSG 1)ERG#125• I C1 oiii ih-+\.aa 'II:>S (:D 24H EMERStNCY#800-468--1760—CH/SK/TFI—Contract retained by generator confers a ency authari y nn initia 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are dassified,packaged. marked and labeledlplacarded,and are in all respects in proper cordibor for transport according to applicable intemational and national govemmentai regulations,If export shipment and I am the Primary Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent, I certify that the waste minimization statement identified in 40 CFR 262.27(a)(hf I am a large quantity generator)or to)(if I am a small quantity generator)is true, GeneratorslOft Tors Printed T; me Signature ` M rDay Year 16.Intema renal Shipments !)� F ❑Import to U.S. ❑Export from U.S. Port of entrylexit: -- i Transporter signature(for exports only): Date leaving U.S,: ir 17-Transporter Acknowledgment of Receipt of Materials Tran r 1 Printed1Typed N�l Signatu Month Day Year a �1�il Z Tran 'note yped Name Sign Month Day Yey 1 —2-1 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number 18b.Alternate Facility(or Generator) U.S.EPA ID Number J U Tai Facility's Phone: LU 18c.Signature of Allemale Facility(or Generator) Month Day Year a Z N19.Hazardous Waste Report Management Method Codes(Le,codes for hazardous waste treatment,disposal,and recycling systems) 3. 4. 26,Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a PrintedfTyped Name Signature Month Day Year 3 + EPA Form 8700-22 Rev.12- Previous editions are obsolete. DISI ATED FACILITY TO EPA's e-MANIFEST SYSTEM 1)790079/13 481