Laserfiche WebLink
SC PPW 10/10/2017 a " - <br /> Haaseplintortype.(Form designed for use on Silly(12-pkh)lypeW>ner.) j) S (J3 Form .OMB No.20500039 <br /> UNIFORM HAZARDOUS 4a@101@�5 91 0 2 211age 101 3�15�,rr � 4.Mao a115 83970 FLE <br /> WASTE MANIFEST �n <br /> bina��tl WAddress Genemlofs Sid Amme,(e different Nan mailing address) <br /> 2526 W.Washington Street 2626 W WashinOon Street <br /> Smakmn.CA 95203 9todcron,CA 99203 <br /> ,momwe x.(20913203714 ATTHdesse Levels <br /> ne sowtent mpany Name U.S.EPAID Number <br /> see Number <br /> 3 3 <br /> T.TmnsPonar Company Name U.S.EPA ID Number <br /> S.Despared!FaSuh Name aM Sim Address US.EFAIDNIvraer <br /> Clean Harbors BuCornrillow,LLC CAD 9 6 0 6 7 5 2 7 6 <br /> 2500 West Lokent Road <br /> Suttomvillow.CA 93206 <br /> FwdydPwne. (6611 7628200 <br /> ya, Bb.U3.DOi OescdPlkn(indWNg PreperbpippNg Name.Hazard Clazs.ID NumNer. fO.CanMkers T.Total 12.UM 13.Wade Coeur <br /> HM FMPamJre Gswr(dmd) No. Tyye Ow" WWN.. <br /> + O.S.,(ARSENIC.CHROMIUML 571 <br /> X 6.PG III,(BOTFOM ASH) / V6 <br /> P <br /> CF = 2. <br /> W <br /> V <br /> M 3 <br /> (ted <br /> d, <br /> lqS g➢I ��cbons <br /> and 4 "llfgtian <br /> 15. GENERATOWSIOFFEROR'eCERTIFICATION: IFarebytleGlare thal the wnteMs oltles osmgnment are lolly aM amrmlelVmscdbee above by th prepersnippirg name.aM aredamgde,pacFagH, <br /> marked and WbekdNlazaNed.aM are N all moral In Fewer wneitan kr bareposl acwNng b spleens lntemardral and Amoral govemmenMl ragulalgns.Ilexpon sbigrentied l am She,Primary <br /> Espmdr, ceNly Nat Ne wntend QIMs mnsi9nmenl mnlmm a tM drmicdNa aaaand EFAAeMrovAeegmenrol Consent. <br /> I ceNyI altM weed nenvrdeadon sleMmeelieantifiM in40 CFR 26227(a)CdI am a Mr9e Rum5ry genembr)or(b)Ie I am a small puanaygemasdr)is we <br /> e s rink alre gn oreDay year <br /> A-WINVs /9 <br /> 18.Intemalanal igldnb ❑lmwodto US. ❑Eolportina US. p9der.06sint <br /> Transpinereqnswersomergarlsonli Dab U.S.: <br /> w 17.TrardWM Z= <br /> os Rempld <br /> "Ad n 8ma Year <br /> d. T \ <br /> aTrmspwler2 FdntalrtYped Name m aV mee <br /> 1 16.Decreased, <br /> 16e Divrea tyl tlna spec 1:1 Clammy ❑TYPe ❑Rmdle ❑ParEel Releclon 11 Full Reatlgn <br /> µ3n11¢51 Randall Numpe' <br /> teb.AlMab Feet,(or Consumer) US.0P 1011umbe <br /> U <br /> rQi Fad' 9PIgq: <br /> Q 1&.SgnebrcdAtlerab Fapllty(ar Genmaka) Month Day Year <br /> 2 <br /> 19.HamNprs Wmb Repel Managemml McNotl Codes li e.,mJesM texallomwasb bmMml,dspwal,aMre Wlrg sysbma) <br /> 1_ H132 2. s. 4. <br /> &l pmgnaled Fauliy p4ieror Operabr:CertikaOonolremipt ofMaNws ma@nals rovelN Cy tlro nanA�mmplasrobtlln lbm lye <br /> 1 <br /> Randall Name r SgnabreMem, Day Year <br /> K °l <br /> EPA Form 8700.22(Rev 3-05) Pr vioua editionsare ob""Ani n[C� syrTc�aJ�aVa�ILITV TO DESTINATION STATE(IF REQUIRED) <br /> Clean Ha eTS has retie appropriate Pennrt5 for and will accept the wage theGMlrarersnNp1a� <br />