Laserfiche WebLink
Please Form OMB N0.205G0039 <br />UNIFORII HAZARDOUS <br />WASTE MANIFEST <br />1. Generetor lD NumbercrL o o o o a t I31 (8oo) 12tl-93001 017533s93 FLE <br />5. Generato/s Name and Mailing Address <br />Olrik Stop Marketsr Inc.165 Elandrra RoadScatborougtr, tIA 01581 <br />Genento/s Phono: <br />Qrlk Stm ltlarksts, Inc. *138f153 Idnbotn BIvd:TrarrJrr CA !Xi376 <br />Genemb/s Site Addmss (if difiarent han mailing addr€ss) <br />(5101. 4 5-22821 <br />erBoool83tr.3BELBHINE <br />8. Designabd Facility Name and Site AddressIorld Oll Recycllng <br />20OO N. Alarda St, <br />,ffiPt#fiP' m eo222 <br />U.S. EPAID Numbercrro80013tse <br />(310) 53?-?100 I <br />10. ContaineG9a. <br />HM <br />9b. U.S. DOT Description (including Pmper Shipping Name, Hazard Class, lD Number, <br />and Packing Gruup (ifany))No.Typa <br />11, Total <br />Quantity <br />12. Unit <br />W.r'Vol. <br />13. Waste Codes <br />13t <br />nn+ <br />[lI <br />? tf) <br />GIt <br />I' Ui[203, Gasoltne lrflrtunrr 3r Ki If <br />2. <br />3. <br />4. <br />her€by declars that the conbnb of his consignment ao fully and acdrably doscribod abovo by ho pmpor shipping namo, ad ar€ dacstfied, packagod, <br />Expoilor, I Grtify hat he mntents of this consignmont conform b the brms of tho atbchod EPAAcknowlodgment of Consent <br />AP9ROnr'[TB <br />MTru(:rIYE <br />t'- <br />,I5. GEl{ERATOR'S/OFFEROR'S CERTIFICATIOl{: <br />or am a smallhat ths wast6 minimization shbment ldontified in 40 CFR lam a ie true. <br />IGNR AI.I, <br />PGNffIFII, <br />crrn{Ir{Gi. <br />msl:369097 <br />(IrIIGlmP GN: 659137 <br />ERGIc 128 <br />Gasolim t frtcr <br />Eokc,ul2 <br />UJo <br />DayGenenatoddofierc/s Pdnbdllyped Name M0mnslgnaure <br />F <br />= <br />E mpon" u.s.E exporttom u.S.Port of entry/exit: <br />Dab leaving U.S.:Transportsr signature (fur exporb only): <br />1 6. lntomational Shipmenb <br />1 7. Transporbr Acknowledgment of Receipt of Mabrials <br />Signature <br />4I! <br />uoA. <br />aD <br />=E, <br />18. Discrepancy' <br />Full Rejec{on <br />'lSb.Altemab U.S. EPA lD Numbor(or Gonorator) <br />tr <br />Phone: <br />Errp.'18a.Discr€pancylndlcationspaco n Orantty E n urr.n Partiat RepAion <br />18c. Slgnaturo of Altomab Facility (or.Ggnsrabr)Month Day YoarII <br />19, Hazardous Wasb Roport Managsmont M6thod Codos (i.6., codes br hazadous uesto tEalmont, dlsposal, and r€cydlng sFbms) <br />3.4. <br />20. Deslgnahd owner or operabr: Certlfication of raceipt.of matorials covor€d the manibst ex6pt as n&d in lbm 18a <br />( <br />tsJo6 <br />c!ut <br /><-c, <br />aDutct <br />are <br />i 1a <br />Transporbr 2 Printed/Typod Name <br />I <br />Monm Day Yoarttr <br />138/3661703