Laserfiche WebLink
'�'E•• �r�', e!r,p rdt .::'.: 7•«!G'ri.1. C/ / r 111NI11 M1IBl1I111111111Noil III <br /> 0069S3442SKs <br /> Please print or pe. Form Approved,OMB No.2054-�39 <br /> UNIFORM HAZARDOUS 1.Generator ID Number r{i nfooJ'� �-7 12.Pap.lof 3.Fame r Rlspop�e Ptw� 4,llanber <br /> WASTE MANIFEST ` " 006,951442 SKS <br /> 5.GenereWs Name and MaIN Address Generator's Site Addrm(if different than mailhaddress) <br /> ADESA — Gel en Cate AI)ESA — `.�01 E-)e n 6a,e <br /> t3501 West StAnford Rd Attn Samr,cel Mr:henry "501 Stanfe ri Rd <br /> TRACY CA 95377 Attn 1-ester 5ab4 <br /> GenerawsPhone: 209--814--5374 TPACY I:n `9-377•-9708 <br /> s.TTW�§'�-nnl!fR SYSTEMS INC: U.S.EPA ID Number r X RI�t;4t�Q18.1; 171 <br /> 7.Transporier 2 Company Name U.S.EPA ID Number <br /> 8.Designated Fadiity Name and Site Address SAFETY—KLEEN OF CAI..I►_O RN I A U.S.EPA ID Number <br /> 6880 SMITH AVE. <br /> NF�1Aa!'; Cie 94'54'-00CAD980887418 <br /> �<0-7g —4400 ' <br /> Faa'Utys Phone: <br /> ga. 9b•U.S.DOT Demotion(indu ft Proper Shipping Nam,Hazwd Ctass,t0 Number, 10.Containers11.Total 12" <br /> HM and Peeking Group(d any)) No. Type t]uantity WLAlddes <br /> . 13.Waste Ce <br /> t. NON--Rf:P,A HAZARDOUS WASTE, LIQUID � � TT �G J G 221 <br /> QISED OIL) <br /> `I <br /> ag <br /> z z. <br /> W <br /> 3. <br /> 4. <br /> 14.Staged HarKft lnstueftis mrd Additional lnbmotion 7S]j:E L'G [ f; <br /> 24H F_'MERGEhICV#800-468-1750—CH/SK/TSI—Crnxrar_t retained by generator rnnfe-s aggency authori y <br /> an initial transporter to add or 5tthstitute additional transporters on Qenerator's behalf. <br /> 15. GENERATUR'SIQFFEROR'S CER1'"ATM:I hereby dedare that the.0 ftft of Cas donsigrmnem are fully and accuraW desaibed above by the proper shipping name,and are dssOed,peO aged, <br /> marked and labdedOacarded.and are in a0 respects in proper condition for transpo i avow g to sable international and natronal govenxnental regula m.if export shipmeM and I am the Primary <br /> Exporter,l w*that Ore oorw. of this ranagmwg conform to the temps of the attad+ed EPAAdm WeQmeM of Consent. <br /> I Wy that the waste rrrgdlniretion statement identified in 40 CFR 26227(a)(if I am a targe quantity genwW r)or(b)(if I am a email did wit generator)is true. <br /> Day V�w <br /> tow`"' l� �+2 <br /> 5 ,z,re Month13 <br /> hA <br /> ,,,t 16.Interrdatlaral Shy <br /> �— OF <br /> ❑inw'l to U.S. ❑Export from U.S. Port of entry"t: <br /> z Tramwrbar Signature(for 0*): Dale leaving U.S.: <br /> I 17.TMmporfer&dmowla pwd of Recap of MalwW <br /> T PdrdedRyped Morin <br /> l 11/21 Day Year <br /> Z T n yped <br /> Month Day Year <br /> 1 e-Disaeparrey <br /> 18a.Dlsaepancy Indication Space ❑ ❑Type <br /> ❑Residue ❑Partial Rajediaf ❑FvH Rejecflon <br /> Manifest R Number. <br /> 18h.Altemata Fapfity Ia Generator] U.S.EPA 10 Number <br /> E5 <br /> Facility's Phone: <br /> 18c.Signature of Mtemate Faiity(or Generator) Month Day <br /> Year <br /> 19.Hazardous Waste RRgwt Mattagemerrt Method Codes(i.e.,oodes for hazardous waste treatment disposal,and recyding systems) <br /> LU <br /> � 1 <br /> 20.Designated Facility Owner or Operator.Certification of receipt of hazardous materiels covered try the maWW except as nated i n Item 18a <br /> PrinterYfI Name ♦ Sign Month Day Year <br /> G �ti Y 1 <br /> .PA F #4707{ v 1j) Previous edrlrans�e obsolete. S <br /> MATED FACELITY TO EPA's e-MANIFEST SYSTEM <br />