Laserfiche WebLink
r ry r <br /> r F <br /> wie889 grinl Or type. iFORA roved.OMB t14.20":l9 <br /> UNIFORM KAT.ARDOUS 1' rotor ID.Number 2,Page I of 3.Emergency Response Phare 4 Man t nc nQu �� �+ <br /> WASTE MANIFEST 001523337 1/E�7 <br /> 5.Gaaerotors Name and A,ailirrg Address YC LE111"QAI.VAN WW81 rb S8e AMMU T Mnent than malakV address) <br /> =1DC(4ROC1m sA1� <br /> SUSS ROOD WAY <br /> Ga�to$PPhhone9S377 72t7 <br /> B.Transporter 1 Company Name <br /> U.S.EPA ID Number <br /> VAOLIA 15TBMDWAL 6t UTMM IN ] D 0 B 0 6 3 1 3 G 9 <br /> 7.Transporter 2 Company Nam U.S.EPA ID Number <br /> TRI ITATE MDTOIL TRAMT 00, li[ O D 0 9 S 0 3 i 9 6 <br /> 8.Designated FacW Name and Sb Address U.S.EPA ID Humber <br /> VEULZA go TSMOvicA L,�. <br /> L.L.C. <br /> 1704 W Fll W*]XM <br /> Fadi s Plwne: XM 33""2 AZ0&kCA 91702 C A D 0 0 6 3 O Z 9 0 3 <br /> ga. 9b,U.S.DOT DoWptlan(Wlu ft Proper Shipping Name,HazardCt <br /> ID Number 10.Can,ainars 11.Total 12.Unit <br /> HM Paddrp Crorlp �Y)) Na. Type Quanuiy WW". 13,Waste Codes <br /> it X f' TTIM1PART R=ATZDMATH1dAL Tn003 D" 331 <br /> PALM` .DRTM, VHW CK <br /> �• ff+ 1 C F 20 P pDOIS D03R <br /> W x 2' Ulw1 WAB=FLA)JWA=U ,urs <br /> �OaM W WOM.OtPANM&3.11 FOB U057 U239 <br /> 2: ID U 399, P PDQS WSP . 212 <br /> x a' UM175,WAffI%J60EC.OIRARSM Dt>wDt <br /> 1 D F 64 P 3S2 <br /> x 4' LW1nWAM8W=0MTA1NW Ir003 3521 <br /> IiI�1LQ i tit LA1�IRfA'1'1;q <br /> ,90i.V3lVTs1�,+1,1,ff i 1 D F 16 P DDOI ; <br /> 14.Special Handling instnrctions and Addftlpnal In <br /> --- ,rma8on 1BR OF 1 P! A by VBM + C0011110d,M 6kwd by <br /> ZI�W-1 � + BR41:12113:904261 <br /> '�?X0:133 Sit: 10557 11 4j 131 :133 W:7154i A.A&L <br /> 15. GENERAWR'SIOFFEROR'S CERTIFICATION:I hereby declare that the nts of this OWWOrmint are fully and accurately deaaibed above by the proper shipping nam,and are classf .*Nod, <br /> marked and iabekdlplacarded,and are in all respects in proper condltion transportacwrding to applicable k6mabk4and na5mel governmental regulations.If exporl shlpmentam I am the Primary <br /> Exporter,I cergy 1hat,he oonlenta o,thk oor�signment conform 6b the <br /> Otto atlached EPAAdcnvxledgment of Coneers! <br /> I sanity that the weal@ mlal ntalstsment identilled In 40 CFR 282.27()(if I em a targe quardfy generabx}a @)(dI am a ametl quan8ly generator)6 hue, <br /> Ge ta's101Feroes Priam Typed Name WOW 04—y Year <br /> -j 18.Intamational Shipments <br /> ❑import to U.S. ❑upon flan U.S. Port of enhylexit <br /> Transporter sipna(ure(for exports only): Date leaving U.S.; <br /> w 11.TransporterAeknow %mentof Race)pi of Maledala <br /> Trartsperter 11 PnnWyped Nama Slgaehrre Month Day You <br /> d <br /> Ttians Pdn yped em Month Day Year <br /> f7i4 t G,�^ r <br /> 18.Discrepancy <br /> ,8a.Discrepancy Indication Space ❑ Quarttiy ❑Type ❑Resides ❑Partiat Ra)edfon ❑Full Re)ecW <br /> Was1temale Fadl t 90*01 ge Number18b.A <br /> lb'(or Generator) U,Sr EPA IA Number <br /> LL Fadliiys Phone,; <br /> yj 18c. nature of mate Fadliy(or Generator) M"W th Day Year <br /> 19. <br /> ftl@ Report Marumenxant Me"t:odes(l.a.,ood"lar waste home diapoaai,and racyding systems) <br /> 4, <br /> 141 <br /> 20.Designated Fady{lunar or Oparafor:Cert on of receipt cr NuNdI ua me"Is covered by the manifest a as Item 18a <br /> araeIAt <br /> N' t 14 1 Pr W I X 1 IZ.jl+a 1- <br /> 1h ay <br /> EPA Folin 8700-22 Rev. -171 PWom editions are obsolete. 4 DESIGNATED FACILITY TO EPA's a-MANIFEST SYSTEM <br />