Laserfiche WebLink
0 <br />Please print, or We. Farm designed for use on elite (12-plgh) typewnter.). <br />:f • <br />Fall Approved. OMR NO.2OW039 <br />EPA Form 8700-22(Re*3c05) Previoused'iYoriaare obsolete. - `VCSIGNATED FA TO DESTINATION STATE OF REDUIRED) <br />UNIFORM HAZARDOUS 1. GenOMtOtIDNumbel <br />2.P401of <br />3.EwgencyRo C <br />= <br />0.BanlesatalJingNumOer <br />WASTE MAIAFEST 0 89375 <br />1 <br />007083765 JJK <br />S. Gamntor% Name and Naifing Address GenewlarsSitedwe(i rent Man magngaddreas) <br />Pick N Pull-Stackctan 3927 C1arle brute A+.t=: Doug Graze <br />3927 Clark Drive SterJetou, CA 95205- <br />Stackttan, CA 95205 <br />Generatoes PMw: <br />S. hanMMer 1 COmpaay Name US, EPAID Number <br />7. ranepodar2CwnDany Nacre U.S.EPAID um a <br />Ia tr' <br />8. Designated Padlly a ane SIMAadreSS U.B. EPAID NvwW <br />AA S=duol, LLC. <br />1925 H. Fa4oz Ave. <br />Tena, AZ 85365 <br />FaaWSPlane: 921111-783-3979 <br />Be. <br />eb. US. DOT Oesoprmo(induding ProperS upping Namq HwrdClm% IONumbe, <br />10, Containers <br />11. TOw <br />12 Une <br />13.wadeCodw <br />No. <br />Type <br />HM <br />and Pa3atg GmW (raMW <br />Oua0lb <br />M9Nal. <br />1.11111ma-SOPA 6tacazdous *satee Solid Cl ily <br />9� <br />IO.6 <br />352 <br />g�g <br />Absoarleewrt, Drbzis) <br />C!f <br />P <br />z <br />2 <br />w <br />s7 <br />3. <br />r <br />d. <br />1 . Spatial HanOsng Inswcaant andAdAOonal lMamlaOon <br />� 515727 -SLi <br />Lill to Wozlaride; icaw Appzapiatc PzotcatiVu Clsat2aing <br />is. GENERATOR'SNIFFEROR'S CERTIFICATION: Thereby OedeM MazMe wnfens ofmR onagnmentae fullyaM aramunydasdibetl abOs's by 0t8 proDu 9hippbgnamq sv era dessl0ed, padwged, <br />msayatl andlsaelgs'plxaded, and en in all reepeda in pmpxcondlbn forbenapod essarding Io appllaNd iMemadowlaW nadaral gasmmenbl ogulsOOne, ilopom stdpmant xb l am uhe Phnary <br />E%pader, I cer*lhat Me wmama Of Nis COMi M"t wnbrm to McWM of ea amdad EPAAduroyMpant of Consent <br />lwdfy that the waste Wnimnabon Metanonl identified in 40 CFR25227(a)(ifl am a" 0uamltygenel Ow tam mellquentitygenaratu)ISWe. <br />Gelereta erola Printe Name Sgrolu O't+ ay Year <br />e4l 2� vo <br />r r� ; <br />J <br />f <br />1fi.Intemellolat 5niwnen ❑ImpORMUS ❑Expel tmm U.&. PoaofenVane <br />? <br />7mnapoderSignature (km exports any}- Dek karirg U.S.: <br />W <br />IT TranspoterAdMoMedememofRacWOfMaledals <br />may, <br />Tranaponerl PoMedliyped Ne gnaws arond+ Cay Yee: <br />S <br />7 <br />Transporter llypas Name SiyaWro Month OaY Year <br />T <br />le. Mcrepancy <br />I <br />tea 0bcrepancy indiwpw Spew ❑ Ooantlgy ❑Type ❑Ruidua ❑perw Rejad. El Fit Rejedlon <br />MrifqdReferenceKtmter <br />1Bb.Allamala Fadlity(or Generalor) LLS. EPA ID Number <br />7 <br />U <br />k <br />, <br />Fadiityt Pnow. <br />w <br />t&. Slgnawrsef7j" Fadliy(arOMMI r) Month Day Year <br />a <br />a <br />19. Hszoduus Wade Raped MwagMrenl Method Cod" (I.&, codas for hualdOUS WOW OeeMent. disposal and req•Cang SySIMS) <br />w <br />o <br />2. 3. <br />4 <br />21Designated FaO8 Own w0p0mWr aa! <br />rewipf amaladals covere0 by 01e manliest ae rp nl 1Be <br />PdnmdRyped <br />re M <br />N <br />Z'Ak'gn <br />EPA Form 8700-22(Re*3c05) Previoused'iYoriaare obsolete. - `VCSIGNATED FA TO DESTINATION STATE OF REDUIRED) <br />