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d:'Ganeroror� roans_ .s.... <br />5. 7ronsporter 1 Company Homo„ 6 US EPA ID Number ti r C rState rmu oda Ilk Rose ' <br />o - <br />co <br />Eco Si@s91812,03, 173' <br />°? 7. Transporter 2 Company Name S. US EPA ID Number <br />tdTraa$ � iD: R � <br />„ ; 9. Designated Facility Nam® and Sdo Addross 10. US EPA ID Number State Facfiiy s il3 <br />d Philip Services Com. -Rho -Chem Faciiity <br />Z 425 leis Ave <br />H Facility's P i t'4-1 � <br />v o -Ingi®vtrood cA 1 A 3 6 4 2`� (323 T <br />?6 <br />VQ 12. Containers 13. Total J 14 Unit i:� ' <br />V 11. US DOT Description (including Proper Shipping Nome, Hazard Class, and ID Number) No. T e Quantity Wt/vol 1 Waste Num <br />? VF <br />sive solids, n.o.s., 8, UN�1759, PG II sroro t°Y <br />_ .ti <br />G ic acid, absorbent) a 2 p F 01 6� o EPA/Other �� � <br />o NCRA hazardous waste, liquid00 <br />Sroro �y <br />E( used motor oil) 0,10 Z D <br />(tM ® o o EPA/Other <br />' <br />v AState s <br />T Note-Rv hazardous was#e, solid2IV <br />O EPA/Other <br />0° R (oil,floor sweep) 00 1 i) M O 0 y S C. <br />w d. State <br />Z EPA/Other <br />W <br />lJJ F '3 <br />K. Handing Codes for Wastes listed Above <br />r� <br />Uj 11c iA1r 5! t� S3 4 L SSG}Pra4it�g19007 = `fr c. d. <br />�f K <br />Z 0 'n nd di nallnfo ` ion <br />bD <br />while handling. Weights or volumes are approximate. 24 Hou <br />Z emergency telephone number (200) 321.2470 (ECI Dispatcher' <br />=Gl Jo 243324 site: grocery -produce warehouse ER ' 1 ap 7 R� <br />16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurate)y described above by proper shipping name and are classified, packed, <br />marked, and labeled, and are in all respects in proper condition for transport by highway according to applicable international and national government regulations: <br />If I am a large quantiy generator, I certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically <br />H practicable and that I have selected the practicable method of treatment, storage, or disposal currently available to me which minimizes the present and future threat to human health <br />and thq environment; OR, if I am a small quantity generator, I have made a good faith effort to minimize my waste generation and select the best waste management method that is <br />available to me and that I can afford. <br />0 Si pato' Month Day Year <br />>_ Printed yped) `Name _ 9 fi12 <br />% U <br />Z /Tii� % . %J�O�`"i� / <br />w R 17. Transporter 1 Acknowledgement of Receipt of Materials <br />W f 11Cs'tN"1� °"v�o <br />LL. ® 1 B. Transporter 2 Acknowledgement of Receipt of Materials _ Month Day YearJ' <br />0 v Printed/Typ4lJ Name Signature <br />