Laserfiche WebLink
Stale of Co ed O No.2 and-0031? Agency See Instructions On Back of Pa a (kppaartrtyrtt of t�eaftR 8efylCer <br /> Form Approved OMs No.2050--0030(F�tpirea 9•;In o f� � � _ r : >, .� T ,9t+bittFllCRM..�pAtfQ1 CIYf>fIo <br /> Please grief or type. Form deaJpned for use ort PprYcdr typewriter!. <br /> x <br /> UNIFORM HAZARDOUS .: t. awaratoe2 us CPA 4- ;, y <br /> WASTE MANIFEST 19AD1 <br /> f s i - <br /> 3. Generator's Name and Mallin Addr <br /> TRI VALL Add PLNT T ' , z <br /> IFORAL.I FT <br /> THORNTOIV nrr ' OA '� <br /> 4. Generator's Phone 09) 794-2303 <br /> 6. Transporter 1 Company Name 8. U4 EPA_ ID Number <br /> fi Y—KI-EEN CORP. A 1 � <br /> N .•. <br /> tin 7. Transporter 2 Company Name 8. Us,EPA tD Number . <br /> 9. Designated Facility Name and Site Address 10. US FPA If? Number <br /> -a SAFETY-KLEEN CORP. <br /> U 5050 SALIDA BLVD. <br /> PO BOX 555 CAT 0006139" <br /> SAL I DA>, CA 45368 �4 <br /> n 0 12. Containers 13. Total 14. r <br /> t1 11. US DOT Description(Including Proper Shipping Name,Hazard Claes,and!D Number) Quani Unit R11 ' a <br /> No. Type Wt/vol '�" <br /> c �>ap WASTE PETROLEUM APHTHA stater '74177 .. i <br /> z G COMBUSTIBLE LIQUID UN1255(D001 ) (ERG #27) Dial P <br /> E EPArtxttK <br /> �.] lMr!w1+� <br /> 3 N <br /> n IV141 <br /> E b. State I <br /> R .�` ' ! <br /> A <br /> ca T <br /> v O <br /> C4 R C. r. 4 <br /> . - <br /> Pr <br /> q?' <br /> w d. .41att , <br /> H <br /> Z <br /> W <br /> PA/Other <br /> (0J. Additional Descriptions for Materials Listed Above H tNeatad►I1Att1M1, . <br /> A) D0 SOS >�r, f <br /> a Y a1#/r rtes' in <br /> W - <br /> fit <br /> cc <br /> 4 w <br /> Frl <br /> s"t <br /> t 16. Special Handling Instructions and Additional information 9125 27926567 31"7 y —181-'01 4453 r,.� <br /> EMERGENCY RESP#70e—B8$-4660 660 24HR 7Jrt. T7 7[7 ai iv 1—'T �� <br /> w <br /> SKDOT# A: 501 8: <br /> V 16. <br /> GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name <br /> and are classified,packed,marked,and labeled,and are in all respects In proper condition for transport by highway according to applicable international and <br /> EL national government regulations. <br /> If I am a large quantity generator,I certify that I have a program In place to reduce the volume and toxfeity of waste generated to the degree l have determined <br /> ix O to be economically practicable and that I have selected the practicable method of treatment,storage,or disposal curreetty available to me which minimizes the <br /> present and future threat to human health and the environment;pR,if i am a small quantlty generator,I have mute a good faith etforl to minimize my waste <br /> } generation and select the beat waste management method that Is available to me and that I can afford. <br /> CJ , <br /> Z <br /> Printed/Typed Name Signature Month pay Year <br /> (D <br /> W T 17- Transporter 1 Acknowledgement of Receipt o1 Matenala �--�-- <br /> R OF <br /> Z A Printed/Typed Name Signature Month Day Year <br /> 4 <br /> LL s taael Thornton <br /> P <br /> W 18. Transporter 2 Acknowledgement of Receipt of Malenala <br /> � <br /> FPrinted.,Typed.Name Signature Month Day Year <br /> 0 P <br /> Z <br /> 19. Discrepancy Indication Space <br /> F <br /> A <br /> G <br /> I <br /> L <br /> 1 20. Facility Owner or Operator Cartification of receipt o1 hazardous materials covered by thi manifest exc A t as noted in Item 19. <br /> T <br /> y Printed/Typed Name Signature Month Day Year <br /> Tim Perez <br /> DHS 8022 A Do Not Write Below is Line <br /> EPA 870022 <br /> (Rev.8-89)Previous editions are obsolete. - <br /> Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS <br />