Laserfiche WebLink
SSL SK SHIP# 233364303 11111111111111111111111111111111111111 <br /> 0 0 7 5 7 4 7 5 2 S K 3 <br /> Please print or type Form Approved 010$No 2050.0039 <br /> UNIFORM HAZA RDOU5 Cae"aralor 10 Number CAL0003290a 1 I"a"' of 3 Fn—T"RgCft @ 4 ManifestTracking Number <br /> WASTE MANIFEST 1007574752 <br /> KS <br /> Herat: e anp Mailing Aooress GeneraWs Site Address lrf diger 1[h.ar, rae,^. anar•;- <br /> upstate Equipment Sunstate Equipment <br /> 5552 E. Washington St. Attn: Annie Hodell 75 E Equipsent Ct <br /> PHOENIX AZ 85034-0003 <br /> Generators Phone: 209 463-1682 FRENCH CAMP CA 95231 <br /> e Tr�p*ctoripr fi SYSTEMS INC u S.EPA 1D Number TI[800008120-� <br /> 7 Tran�s�po�rtter 2 Com an Name US EPA ID Number <br /> CLEAN AM RS ENV SVC INC. MAD039322F50 <br /> 8,Designated Facility Name and Site Address CLEANHARBORS OF BUTT❑NW I LLOW U 5 EPA ID Number <br /> 2500 L©KERN ROAD <br /> BUTT❑NWILLgW , CA 93206 <br /> 661-762-6200 CAD980675276 <br /> Facility s Phone <br /> ga 9b U S DOT DescriplHlrr lkntlud ng Pincer Shipping Name Hazard Gas*.10 Number. 10 Containers Talar 12 Unit <br /> HM and Packfrrg G�oun lu anyll ?3 Waste Codes <br /> No, Type Otlanlrry Wl.Nol. <br /> t NON RCRA HAZARDOUS WASTE SOLIDS Dr1 P 223 <br /> 0( DEBRIS, PETROLEUM HYDROCARBONSI 1 �� —� <br /> a <br /> ,r <br /> w <br /> x <br /> w <br /> c� <br /> LJ <br /> 14 Spacial Handling Instructions and Addiltonal Inforrnalion TSD•HL 85287254 SU31046 CSS: <br /> 24H EMERGENCY#800-468-1760-CHISK/TFI-Contract retained by generator confers agency at.<thori y <br /> on initial trans orter to add or substitute additional transporters ongenerator' s behalf. <br /> 15 GENERATOR'SIOFFEROR'S CERTWPCAT}ON: i hereby declare that the contents of this cxWrnent are fully and accurately described above by the proper stopping name,arld are dassrfipm packaged <br /> mamed ano:abeledrplaratded.aro are in all fespeos in proper condition tot transport according to apoicabie international ano national governmental reguiahons if export shipment and I am the Primary <br /> Exporter,I f*rtrfy that the contents ut this consignment conform to the[arms of the attached EPAAcknowledgment of Consent. <br /> I certify[hal trol waste mmrmxxabon statement identified in 46 CFR 262.27{a)tit I am a a oe qutwby or ib)Id i am a s^-a' ,, [t generrav)is tree. <br /> Ganeralor'slOtferors Printed,7yped Name Z <br /> MD01 Day Year <br /> Prf V k 21-- 1 / <br /> 2s j <br /> J 18 International Shipments ❑1 nPa1 m U s <br /> ❑Enw from U 5. Pal of enu•r <br /> Transponer signature i for exports only). pate leaving U <br /> IX 17 Transporter t of Receipt of Malenals <br /> Transporter 1 Pnnted+Ty Na S,ar, rMonth Day Year <br /> aTion orter 2 P dTyped Nam! �IzgflataMonth Day Yr-ar <br /> 18 Discrepancy <br /> 18a Discrepancy Indication Space LJQuantity ❑Residue ❑Partial RelecWfi ❑Full Rejed ian <br /> I_ .Type <br /> Manifest Reference Number <br /> tab.Atterrrale Feeley for Generator) US EPA 10 Number <br /> J <br /> U <br /> tai Fapldys PhOnN <br /> lac-signature of Alternate Fadlity,(Dr Generator] Month Day Year <br /> a <br /> a <br /> t9 Hazardous Waste Report Management Method Codes[i.e..codes for hazardous waste treatment.disposal.and recyding systemsUJI ) <br /> � t 2 3 4 <br /> 20-Detaagnated Fanlily Owner Or Operator Cerhficaliun of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Pnntedrryped Name Lrn Mon_h Da', Year <br /> �e 1 � x Mo •�C0. �rr. ti I Z$ z) <br /> EPJ) lg1Q r,4ZAyRtous edittans areobsWew. DESIGNATED FACILITY T4 EPA's e-MANIFEST SYSTEM! <br />