Laserfiche WebLink
Fot1n Approved.OM@ <br />pease <br />Armor pipe.Ircrn wmm <br />UNIFORM HAiARD0U8 ID NUMr; o r ' . {} <br />2 Page 1 o1 <br />i..., <br />3. Enver Response Phone <br />4. MenHnt hecHnp <br />umber <br />yFOPMASMVIANIFC,;A'L Of 0 3 1 9 4 5 9 ., <br />42 <br />S00) 424A300 <br />00711969 <br />- GeneatoraSlbP,dbess(HNAereMtlranmalMgeddraas):.-�«:.. <br />5. AANDLUBE-WES197- <br />2815 W aRANTLINE ROAD <br />TRACY CA 6G30A <br />209831001 r <br />Garees�s fie' U.S. FPA ID Number 7 <br />6. Transporter 1 CartCmY Name <br />AS13URYENVIRONMENTALSERVICES C A D 0 2 8 2 7 1 0 3 6 <br />7 Transporter Name U.S. FPA ID Number <br />P2 �Caroeny <br />6 <br />? GEMENT u.s.EPA tDNaroe <br />H M�OmAL�NAS <br />36261 OLD SKYLINE RD <br />0 0 0 6 9 6 1 1? <br />KETTLEMAN CITY CA 937.39 CAT <br />�)3-9711 -- •. <br />Fadi aPhone: <br />ga, <br />9b. U.S. DOT Deswlplan (hooding Proper Shipping Name, Hazard Class. ID Number, <br />10. Conla r e s <br />11. Total <br />12, Unit <br />13. Waste Codes <br />No. <br />Type <br />HM <br />end PaddingGroup (dwy)) <br />Quantity <br />wuVol. <br />1. <br />o <br />NON-RCRA HAZARDOUS WASTE, SOLID j01LY SOLIDS) <br />C% <br />�, <br />P <br />Pm <br />z <br />2 <br />W <br />(7 <br />3. <br />4. <br />14. Special Handing Indra ons andAddidonal Information <br />NAERO#981.170 "PROFILE #981:8226 1OILY SOL! DS PO#A110117Q05' PROPRIATEPERSONAL PROTECTIVE <br />EQUIPMENT LaASSr/714 <br />,. <br />15. GENERATOR'SnOFFERORS CERTIFICATION: I hereby declare that the contents of this mnsgnment are fully andscausraly described above by the proper shipping name, and are classified, packaged, <br />marked and Iabel"plecarded, and are he all respects in proper oonditan for transport aocondin9 to apok-able International and national governmental regulations. If export shlpment and I am the Primary <br />E ortw, I cantly that the contents of this consignment cohf sM m the terms of the emadred EPAACknoWedgment of Consent. <br />I certify that the waste manimostion st$tement i 92fified In 40 CFR 262.27(x) (dim a large quantity generator) or It, dl am a small guanglygenerator) is true. <br />GererabrdO6emrs PrinleNTyped Neme SigreWre Month Day .Year <br />y� Mayo <br />F <br />16. International Shipments <br />Import to U.S. ❑ Export from U.S. Port o/enbylexie <br />TmnWW signature (for exports only): Date leaving U.S.: <br />K <br />17 Tracspoder kkrr.ledgment of Receipt or Materials <br />Transporter I PsntedRyped Marne Mo Ih Day Year <br />a <br />L" <br />Trens2 PdnWffyped Name Slgnalars Month Day Year <br />poner <br />r <br />♦ <br />ta.Dr,panev <br />J <br />I.. W'UtlPalfl�cey jn,Lwu}W�spJeCe��/'� dy��//yy ��w.k/�t�\B Qy�y��(❑y I�i�GAdh a/����y��, 1k��,J rtela�e (� <br />,� i L �UG �A.. zooea wjwcsf V u&o6oW� lei 10 <br />MaNlest Reference Number.J <br />tlfb. Alternate Faciliy (or Genaraor) U.S. EPA ID Nurnber <br />J <br />U <br />4 <br />1&:. Signarurn al Alternate Fat lily (w Genaarotl <br />).b":h U"' •�es <br />Q� <br />2 <br />� <br />19. Hera <br />us Waste Report Management Metlod Cady (I.a., wtlea for hazardous waste treatment, disposal, and recycing systems] <br />Mot <br />1. <br />/1 <br />(/ <br />2. 3. <br />4. <br />y --i va; I Ir,.z i r-�pt of l: - ro a'm;,mdms .c.orc dd7lham las mein glom lfia <br />P me re Mon <br />tPA norm 67w-[[(f(ev.a-uo) rravlous eomors are wao,... E3D SI ATED FACILITY TO DESTINATION S IAI r pr esCUUIIICU) <br />