Laserfiche WebLink
. 96L SK SHIP# 231245909 111111111111111111111111111111111111 <br /> 0 0 7 6 2 9 9 4 9 S K S <br /> Please print or type. Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1,Generator ID Number CAR000055301 2.Pagg 1 of 3.Enwreegcv Reslmn__Dlpe. 4.Manifest Tracking Number <br /> WASTE MANIFEST L C4V 4Cft5 1/Ct1 SKS <br /> 5.Generators Name and Mailing Address Generators Site Address(if different than mailing address) <br /> Tracy Honda <br /> 3450 Auto Plaza F'kwy <br /> TRACY CA 95376-0000 <br /> Generator's Phone: 209-832--1400 <br /> 6 rfTY-O MWeSYSTEMS INC Us EPA to Number TXk000081205 <br /> T.Transporter 2 Company Name U.S.EPAID Number a <br /> l/ <br /> 8.Designated Facility Name and Site Address THERMO FLUIDS INC U.S.EPA ID Number <br /> 12533 SE CARPENTER DR <br /> CLACkAMAS OR 97015-8985 <br /> 503--788-4616 OR000002519i <br /> Facility's Phone: <br /> ga 96.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes <br /> HM and Packing Group(if any)) <br /> No. Type Quantity W[Nol, <br /> 1 NON-RCRA HAZARDOUS WASTE, SOLID Dh , P 233 <br /> o (DRAINED/UNDRAINED USED OIL FILTERS) ?) erh <br /> u, <br /> Z 2. <br /> U.) <br /> 0 <br /> 3. <br /> 4. <br /> 14.Special Handling instructions and Additional Information TSD:TPO 82992087 TR34107 202020� C �+�._.a.•u(,Q,y-a T J <br /> 24H EMERGENCY#800--468-1760-CH/Sk/TFI-Contract retained by generator confers agenvy aabalf. <br /> on initial transporter to add or substitute additional trans or'ters on enerator`s n troll. <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION:I herchy declare that the contents of this consignment are fully and accurately described above by the proper shipping name,arra are classified,packaged <br /> marked and labeledlplacarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations.If export shipment and I am the Primary <br /> Exporter,I cedify that the mntents ofthis consignment conform to the temis of the attached EPAAcknowledgmem of Consent. <br /> certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if 1 am a small quantity generator)is true. <br /> Generators1011erors Printed/Typed Name V � " t O Signature Month Day Year <br /> b 7 I{Ci 1Jif�` <br /> 16.International Shipments <br /> H ❑Import to U.S. ❑Export from u.8. .Porto{ trylexit: <br /> Z Transporter signature(for exports only). _ Date ing U.S.: <br /> X 17.Transporter Acknowledgment of Receipt of Materials <br /> Transpo r 1 nteof "ad me Signator Month Day Year <br /> AAO <br /> d <br /> Z Transporter Ptimadayped Name Signatu i Monrtn �Dary Year <br /> J SCJ <br /> p <br /> 18,Discrepancy <br /> 188.Discrepancy Indication Space ❑Quantity ❑Type ❑Residue ❑Partial Rejeotian Ll Full Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Ganerator) U.S.EPA ID Number <br /> 1 <br /> V <br /> ra Facility's Phone: <br /> W 18c.Signature ofAltemate Facifty(or Generator) Month Day Year <br /> 4 <br /> z <br /> 19.Hazardous Waste Report Management Method Codes(i e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> LU I <br /> 11141 2. 3 4. <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Panted/Typed Name ` Signature Month Day Year <br /> J-e,, S ,AJ I 1,ir I W 12.4 <br /> EiAfpM00 <br /> 2Ory i89Z1srevi0 <br /> editions areobsoiete. DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM <br />