Laserfiche WebLink
� `}��seti s , -:�-a�.. r'w µ M,.. .. r ...Xt!^wgr. ^CWFW��F'ns`na�-.V I�r[O'1 a Y.r ., a s.�^Taf�ry�p^JYAyrp}f Y.a•:, r-�Y- -a d,+ry,�x a +�.�XF 'r�Ty <br /> Stale of taLlomlo—EnarOninsibal Protection Apancy N �j t ;ti i��a r,:'F <br /> Form Approved OMB No 2050-OW9(Expects 9.30,96) See Instructions an back of page 6 Department of Tax, sabatftncss Control <br /> +Pieaq pont or type form deypned ter use or;shit(JZpltoh)hPe - c - Saarainenta.Catfomia <br /> UNIFORM HAZARDOUS " 1 Generator's US EPA ID No Manifest Document Nd 2 Pagel Information in the shaded arear< i <br /> rs not required by F*deral Iq+Ar,3j <br /> WASTE MANIFESTr 1A 1i of �a <br /> 3 Generator's Name and Moiling Address <br /> DARPETRD o INC. '4 <br />'N 3150 EL CAMINO CERE98 CA 85307 <br /> oro 4 Generator's Phone (2N) <br /> 3 Transporter 1 Company Name 6 US EPA ID Number i <br /> co <br /> I— <br /> ALLIED PETROLEUMCAL 0 0 0 11JI 2 3 1 4 <br /> —� 7 Transporter 2 Company Name 8 US EPA ID Number <br /> U <br /> Z 9 Deugnated Facdty Name and Site Address 10 US EPA ID Number y <br /> AMERICLEANe INC. <br /> 2570 ALMOND DR. <br /> u SILVER SPRIWS KV 89x429 N V D 9 8 2 3 5 8 4 8 3 � <br /> 11 US DOT Description mdud Pro Shipping � 12 Containers 13 Total 14 tinft <br /> { uy Per ppmg Name.Nozard doss,and ID Number No Type Ouon wt/Vot , <br />' a ! <br /> NON RCRA HAZARDOUS WASTE LIQUID <br /> G <br /> E Tj T G <br /> W N b <br /> .a E <br /> m <br /> T c <br /> O <br /> R , <br /> d r <br /> s <br /> ALLY hr <br /> 0 15 Speaal Handling Instructions and Additional Information PICK—UP AT: 743 E. CHARTER <br /> WEAR PROTECTIVE GEAR <br /> FACILITY 702-577-9001 STOCKTt i CA <br /> GENERATMR 208-537-0771 <br /> 16 GENERATOR'S CERTIFICATION I hereby deck"that the contents of this consignment are fully and accurately described obove by proper shipping name and are classnfN4 ti <br /> packed,marked,and labeled,and are m all respects m proper condition for transport by highway according to appi"ble mternahonal and national government mgulahan" <br /> 4 <br /> If I am a large quantity generator I certify that I have a program in place to reduce the volume and toxrcty of wash generated to the degree I have determLwd to be <br /> a economically practicable and that 1 have selected the practicable method of treatment,storage or disposal currently available to me which minimizes the present and fvtan <br /> threat to human health and the envnronmedn OR, if 1 am a small quantity gewrolor, t hove mode a good forth effort to minimize my waste generation and select the best <br /> waste mono ement method that is available to me and that 1 can afford r� <br /> Y PrmtedJTyped N /1/7 Signature Mph pay^ „ Yew <br /> V C� <br /> T 17 Transports% cknowled met of Recti of Materials <br /> A <br /> PnMed/Typed Na S+gnalun t / month Day Year <br /> W Ll <br /> e18 7roru iter 2 Ac howled menf of Receipt of Matenals <br /> E Prmhd/Typed Name Signature Mom' �`' ,`,YgPr !, <br /> ef <br /> 19 Discropanry Indication Space <br /> U A 1 <br /> C �~ N <br /> l <br /> J <br /> 20 Fool Owner or Ocierator Ceridreatron of rice of hazardous materials covered by-this manifest except as noted in Mem 19 <br /> Pnnted/Typed Name S+grnoturo Month Day -`a Yew <br /> DO NOT WRIT EL THIS LINE, r� •,� <br /> TSC 80 (1/43) <br />[IPA 8700--0-22 Green TRANSPORTER RETAIN5f <br /> ` - <br />