Laserfiche WebLink
Please print or type. _ I •.) Form Approved,OMD No.2050-0039 <br /> UNIFORM HAZARDOUS I.Genomtor ID Number 2,Paga t of 9.Emergency Responso Phone h,Manif(e�st Trac(ki�ngnNumbar /ry^7 �'+® <br /> WASTE MANIFEST CAL00003£it25 209-911-3881 ®V 6 0 4 6®0 7 QBF <br /> E.Generators Name and Mal ng Aiders Generators Slla/Wdress(If dtterenl than mailing address) <br /> MADRUGA IRON WORKS <br /> 305 GANDY DANCER DR. <br /> TRACY,CA 95370 <br /> Generator's Pho 209-832-7003-105 <br /> 6.Transp not i company Noma U.S.EPA ID Number <br /> P.eAERICAh1 VALLEY WASTE OIL,INC. CAR000272302 <br /> 7.Tmnspadet2Company NamaSFERICYCLE SPECIALTY WASTE SOLUTIONS,INC U.S.EPAIDNutnbwMNS000110924 <br /> O.N,taafed Facility Nand and SAA Addresszl ST CENTURY ENVI RONM ENTAL R1GMT OF NEVADA,LLC U.S.EPA iO Number <br /> 2095 NEWLANDS DR.EAST h1V09808D5338 <br /> FERNLEY,NV 8D408 <br /> Fa0t'sPhono775-575-2780 <br /> 9a. fir.U.S.DOT Ocsaipnw(Indudng Proper Shipping Name,Hazard Gass,ID Number, 10.Contalnem I I,Trial 12,Unit <br /> Htd and Packing Gmap(dany)) No, Type OuonGty WI.AW, 19,Waste Codes <br /> a I'NON-RCRA HAZARDOUS WASTE LIQUID DM G 221 <br /> (MACHINE OIL) <br /> z 2. <br /> w <br /> cD <br /> 0. <br /> 4. <br /> 4.,, Handle ImbueGa9s aid Additional lnform6on <br /> 9 li-PROF�LE M 709213-02 MACHINE OIL ERG N 171 <br /> CONTACT;DON <br /> 15. GENERATOR110FFERORS CERTIFICATION:I hereby declare that the contents o(Vs consignment are furry and aocuatlly descabad above by the proper shipping name,add are dasdw,packaged, <br /> marked and Wbeladlplacordad,and aro M all aspects in proper condition for vanspod a oonfing to appkab'e Intemadonal and national govemmontal reguladens.It export shpmenl and I am the Primary <br /> E<porter,I aa6ry that O'a contents of fine cons�gnmenl conform to the terms of the attached EPA Acknmiedgment o1 Consent, <br /> I certify that Ne wash 011,41iva0an sWlemont IdenWied In 10 CFR 262 27(a)(d I am a large quan0t/genam:or)or a small quantity gen r)Is true. <br /> Gena tar0froror's Proo0lyped Name $igna Monty� Day Year n bt tAcPA,�L is 10 1 l <br /> 10,IntBmadonal Shlpmenr <br /> import b U.S. ❑Expo m U.S. Pc � IBdC <br /> TranspoMt a gna4ue(br exparw only)• Data loavng U.S.: <br /> 17.TranspoderAdmmvKdgmem of Racelpt of f lamAals <br /> Tram Pd ped Name ' Ido D Y r <br /> O <br /> N <br /> amrmerz P rype <br /> d r o s yrB Worth Day Y <br /> 18.Discrepancy <br /> I Oa.D-crepaw.y Indrcotlon Space E]Quaa,, f'I <br /> ty El ❑Res4ive LJ PorOal RaccOm ❑fWl Ra}>Ltion <br /> Manifeal Referamx Number. <br /> 18b.Morrato Faclity(or Oonomlor) U.S.EPA ID Number <br /> U <br /> FacicLy's Phone: <br /> 180.5!gnaturo ofAlternme PaciRy(or Ceneamm) 7 <br /> 7 <br /> Day Year <br /> 19,HazaMous Vlaafe Report Managemcal Mallod Codas(0,codas for hawNous waste mirrnn4 disposal,end recycling ay,lems) <br /> wo 1. 2. 1. 4. <br /> 7 1 <br /> 20,Dos'9na!ud Faol-q Qwnet or Operator,CwOflcailon of receipt of hazardous materials covered by NB manifest exe_pt as We/i,Ito.I8a YTI A-1 <br /> Pdntac/$pad Name / Signature L'4. r <br /> EPA Form 8700-22(Rev.12-17)Prevoused(Cons are cbsolole. OEWSNATEDFACILITYTOEPA's0-NIANIFESTSYSTIN <br />