Laserfiche WebLink
DB/13/200.9 12:36 6502664560 NORTH STATE ENVIRONM PAGE 03 <br /> Please print or type, gem designed for pie on elile-(12-pitch) iller,) Fon Approved.OA18 No.20534039 <br /> UNIFORM HAZARDOUS I.TrrorlDNumber 2.Pape t of 3.Emergency ReppMas Phone 4.MARAlr TreoUng uY <br /> WASTE MANIFEST C A D 9 9 1 4 4 7 0 5 5 1 20 -727-5504 0 014 6 8 3 <br /> 9 10 FLE <br /> Generena's She Addmol IIT 0111040 man molingn regia) <br /> P.O. 807( B30 12101 E. BRANDT RD, <br /> L 'IeF'= CA 95237 L40CXZWORD G 99237 <br /> 209-727-5504 X36 ATPIN: STEVE 101REINFp <br /> GManroh Phsrw: <br /> B ` " nvironaslatal (650)589-2938 US bfw to Number <br /> A R 0 0 0 1 5 9 4 5 9 <br /> 7,Trprnponer 2Oompany New US.EPA IO Nimew <br /> U.S.EPA 10 Numbs <br /> 3150 Beet rico Bossier and <br /> Ian Angular G 90023 (000)499-7145 C A D 0 0 9 2 5 2 4 0 5 <br /> Fdc 9P"u <br /> go, so.0S.OOT Ondpmn(Iedodlaq Proper Shipping Nome,Harare CAn6,ID Nlmbef. ID.Condlnon II.Tolel 12.Unk <br /> HM and PoOdrg Gwp(d any)) Na, fYp4 Ouendn vANol. 17 Weae Cadet <br /> p 1 (LASES PA=T) -7170 <br /> UID <br /> 8 IR9TE LIQ / 3170 am 291 <br /> 8 -a00•• P <br /> w <br /> z <br /> Z. <br /> W <br /> CO <br /> 3 <br /> 4. <br /> 14.SpoNal Handing Imn011orn and AddlddMl Informationv�-�- <br /> 1) XRM NOW 27070427 REE PRow, 27070427 / LIQUID 1:�-N✓ <br /> 2: <br /> 3_ <br /> 15, GENERATOR'SIOFFEROR9 CERTIFICATION: I hereby dodera INatRe conforrs ostia mnslgnmrd am fulyind ammlNy dosoNed above by Els pmPRsholft now,and mdalelded,Pooagod. <br /> rta40 and IdpalWpprAndeO,and era In All Telethon IA proper done for banspoll acarding to appkable lenmabonel and national govammenlal regulations.11 ergon shipment am I MI.PMery <br /> Exporter,l ON Thatthe Wmthnr of INS mniyptmantcmlarm to to lamb of Ahsaa6Ned EPAAdmwlodgmeM of Conant, <br /> 1 ra sfyd atths wale mWMITallon stalwart IdllnMed In 40 CFR 26227(e)of I em a large guandy gromfoll I am a small pNanp naabtr)la we. <br /> Uwe e � ` � qna roMnln Day Yoe, <br /> 0 <br /> is <br /> TO International 4hpmeme ❑ <br /> Import b u5 ❑Fsppd ham U.S, Pon oienhyhal!'. <br /> rtse nears br <br /> "pomonlyl. Data WeArg U.S.: <br /> 17.Tdnportor Add tav edpmon of R4plpt TO Maberr, <br /> Prin amthMarrah Yoar <br /> hIC6O <br /> azTre apMer ndrTypad Nema gnat on y r <br /> 1 I9 Discrepancy <br /> 1ee.0ecreprroy lndcaVon SPM ❑Otrenlly ❑Typ ❑Rmidua ❑Penial Relenbn ❑Fuk Re)ecdlM <br /> Mandain R4faronm Number; <br /> 19b,Memale Fadiy(v OensaNQ U.S EPA ID Number <br /> J <br /> U <br /> I Fadi FPkMe: <br /> aw tae 6ipnelure ofAlremlb F6diey lm Danenm7 Month Day veer <br /> Y <br /> n19.Hanadwl Wante Repon Manlgelnant Method Codes(le.,Codas forhramom waste IAalmont,c1lonal,and recyding Memo) <br /> ro ITT <br /> 1 20 Daetpnaroa Fetllq Osr Dpentoc Cert cathndrealp a(hanMaem4erals orverpg Oy the manihelncepl n Town Item tea <br /> Pdnfearryped Name Signature MMI, Day am <br /> 11,91491? <br /> PA Form 870042(Rev,30.5) Previous edluons a e ooeolereDESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />