Laserfiche WebLink
bwp bK ah It-4 eab+ri e{Z� <br /> 0095622139SK5 <br /> Please print or PM. Form OMB No.20N-0039 <br /> UNIFORM HAIARII0U5 1.Genefalor I0 Number 2.Page 1 of 3.Errrargeacy liesporis�Ph" 101, <br /> r g uQ <br /> IAi,sO.It ki01z0u 1 1-C+Vw-Rrbd-iron � VQ SKS <br /> WASTE MANIFEST �7 n <br /> 5.Generators llasrlese d Ma&vAddress GawaWs Site Address(I different than mdog addr¢Ss) <br /> bk-t_i Y-KLr=C.l4 5(=1l=F'la, I111L, a rc+4 RLr.trV �Ysi�Ihay iivi,. <br /> Generator's Phone: er►7 74�r-1 in l i aril_104 LH J;D.5no <br /> S.Trerr�ortw 1 CorN >Y Hemp O.S.EPA ID Number <br /> 3i-ti`,i Y l R kidsys kid i c1t 1 JI <br /> 7,Tr9nstparte3r 2 CoMWy Name L.S.EPA W Number <br /> S.DwqmhW Facft Name and Sae Address kiF i.{+L S>-IJr{iV 11 i U.S EPA ID Number <br /> bdd+f airti I i^i 1-1'vt. i <br /> ids iafch Lk 'j 4Dbw <br /> .',ri+ci--1��-M�io�i i.�Fflt'atrkJdd r 41 d � <br /> F Phone: <br /> ga 9b.U.S,DOT Description(irvAudirg Propel51 11-28_ p6.g7 PA( 1 <br /> HM and Packing Group(a any)) CSG SC-BIlP(MG-01 u ma 1,Jost h R 13,Waste Codes <br /> 1 !tut4-hL Tee+ isi t1:�teliuuti 5deleen Inc, <br /> tJai Uii`a 42 Loyit< Slea, <br /> HoexAt21 � <br /> t ATE: 80 69 540 `�`(`❑_ %P�dq f r <br /> He 2. 24 IN EWI S l(leen) <br /> : WX465-1760[ afelr <br /> 20%451011 <br /> REFEffFJA:F.HBR, <br /> CU$TEIGN SP2G84d Slx>.edco lrL6 Lobe Will fires 9i1589311- M lIM35 <br /> 3 - 944 <br /> 1515 Hoff D, SKC NEEI(: 210-48 <br /> IAay 99 1 231Bijamom Rd SHUC MTf: 1128 2t122 <br /> Hi pan CA 95366-00[10 <br /> 4. PROHE 209-599-7961 <br /> Bill. in CBSIONERK RILL TO AWSS: <br /> L03" Love'a Travel Slops <br /> 14.40MR dingMrrcneMandAddlfiortelNrfarm 106T11 H Permsylvalria Ave <br /> the Village OK 73LD-= <br /> POE 405,4E3-890 TAX Ell i'll <br /> Lot# RFCwOHBLR' 11129-22 <br /> on inLtiai transporter i agrrrcy �t�ir It <br /> P11111WJSEIplIfkS ixLtlr"5 13enrldidi F. <br /> 15 GENERA70R'WFFEROR'SCERTIPICATfON: %-Elvilus1P1411 I ATY UNIT PRICE IAX 191-k ow ard are dassiilW,pwKNWd, <br /> marked and labehxYplacarded.and are in all respE Mn OIL 1.0 T IER I f IEAI 1 IFR t ,rr,eal and I am the Primary <br /> Exporter: ce tify that the Contents of this consignn SM ICEISTOP <br /> I certify thal the waste minimize don statement id an CflOC <br /> Geertralor s f&A"Typed Name �---- sm ICE TEAM 1 AEEK Montt, W YOU <br /> CA145E COTIk UOIf1I1TAf1ERA4A3L11E i;A*01 ENTER WASIE I <br /> t8 Interrla9iona)9lfpttearns 66G36 RD OIL IEL'YCLE 2615A 1iEH <br /> l TlEkI ]TEAT <br /> Ell rnpon to U.S AUTOMOTIVE OIL to <br /> Transporter signat:xe(for expods only): SERUM TIN <br /> USEOE WO HADIE"11 D0OT EAKR NASIF <br /> 17.TransporterAdn wlArnentofReceiptofMaWals f6636 CU OIL RE1911 0.0 11Efl1 TIERI IIERI <br /> TrNsspprler 1 ypedName _ AUfIXTlUE.OIL Mw1h pay Yaar <br /> G f <br /> o SkRV ICE TIIIH 1 lEl[ -C <br /> V l' <br /> T lawmuteNl'ylxedHanle CAIfSE Ca [11t>}IEAi>ERAHT3LiHF Ati81f ENTER tgASlk <br /> Mora Day Year <br /> 18.Discrepancy TOTAL StRU ICE11PRfa'UTS 1 I ER 1 I IER 1 I I ERI <br /> 18a.Discrepancy Indication Space TOTAL CH6AGE T IER1 <br /> ❑ Quantity Uffil Ts I �3` T I€R I ❑Full Ralecctieon <br /> TOTAL DUE TIER I <br /> 18h.Alternate Facady(or Generaigr) SL1� --,2 <br /> + �� <br /> FedWs Ptwr�e: <br /> ffAIU RAIW IH lPl TIER1 <br /> F I8c Sigtneaa dARerrwla FaetTily for roe*ralorl I 1 h i cI rill:ssxa c4: rep. ua t i l l es that I ng spec i f c PCB $i 1 i car <br /> testhu3�ure Ixx+r+:mapleted Nrin to prp>iry this load. ` {�j moo y <br /> � � <br /> S <br /> a * 2_2DW1 ,4� " <br /> x <br /> 40 19.Hazardous Waste Report Management Method Codes LINERMOR SIAI(IS 0-220 lbs wAh <br /> fsu f 2. <br /> C f-IIiJ4 7 <br /> IWsfoa+s eeI ii tics llq! I i 1 t!>c alwre Iwdl.aEel lots are lx uper iy rtlaysi lir_KI. I*d nil• <br /> grIed ar111 IxllelrsT. anti we in proper crxldiIion fa trarespalaIian al—t1iIOJ !o the <br /> 20_Designated Fadlity,Owner or Dperator:Certification of r appl i cvhle I t.j4[lit i us of the BMW I Will of if ww4"tat I Of I i i!to mite ial ..1%mvp Ias <br /> WROTI)wNaas ecwrerl crShel in tlrc j9raete+istics of lire wastcJ.ate+I41 a in IIm lx�'gm"lIitwl <br /> the was IelwAtlk ial, mill(i I i I the a6we rrfn anal Geller alur Status is car rent [ariIow <br /> Month Day Yw <br /> ag eEs is pay it Axywe dw yes Taal to W haexd GY Ow l®ns w%I mall t Tax: (!) set la 11 <br /> EPA Ferm8700-22=Rev.12-17) Previousaditionsareot in tat Il+e[iix:al lean and Caxtiiians isevirlrsf s&µ�uaICIy to 41u.n a (1r) eery Sif <br /> 1 i i ie-4,ji 1]r}(a!1 a,1,~11 sigte<l by W ow r and SI[, and 12) irx.ue lwr aIell 6 a i n fry refer ax.r.- Odes% a-MANIFEST SYSTEM <br /> utirelpisu itxiir:aletl in ills payrralt received section. S1f is autlwrieed I Jlatge Grstaers <br /> _..-_ e r_ of:.• e,ar,.m 1 on tl Galas fat is I Kale lwpml +dean dwt'•, all amazed etpral <br />