COMPLIANCE INFO_2003 - 2007 - Laserfiche WebLink

Home Browse Search

,vr State of California—Environmental Protection Agency —185-01 orm Appri§ved OMB No.2050-0039(Expires 9-30-99) See Instructions on back of a b. Department of Toxic Substances Control lease 1Jrint or type. Form designed for use on elite f 12 piPch) iter. Sacramento,California 1. Generator's US EPA ID No. Manifest Document.Mo. 2. Page 1 Information in the shaded areas UNIFORM HAZARDOUS is not required by Federal law. WASTE MANIFEST C of 1 T1, 30Ge",erator's Name and Mailing Address INTERLAKE A. State Manifest Document Number9 S SACRAMENTO LO LOCA 952 —47 B Stat Generator's ID to A. Generator's Phone (209) 333-3500 , , , ., .. N6.Transporter 1 Company Name 6. US EPA ID Number C. Stat ry Transporter's ID[Reseed j to 00 6SAFETY—KL.EEN SYSTEMS, INC R {) O I D. Tronsporter's Phone aD 7. Transporter 2 Company Name 8. US EPA ID Number E. State Transporter's ID[Reserved.] F. Transporter's Phone �V 9. Designated Facility Name and Site Address 1 10. US EPA ID Number G. State Facility's IDqr ® a `SAFETY- KLEEN SYSTE . INC �ZZ 5050 SAL I DA BLVD H. Facility's Phone mcig:o SAL.IDA, CA 9536f3 CAT {?O�J6 .39�E 0 2 545-1011 ® -' 12. Containers 13. Total 19. Unit V11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) No. Type Quantity Wt/Vol I Waste Number �Z a Stat WASTE COMBUSTIBLE LIQUID, N. O. S IDM � A) A199fII(PETROLEUMN PHTH (ERS 1 )b. 7#/SAL ( 001D01 , 39, N• 1 00 oo E WASTE COMBUSTIBLE N. O. S.E LIQUID, state 7 1 (PETROLEUM NAPHTHA) NA1993 PGIII RQ DM la EPA/Other 04 0 A (0001)E (6. 7 L.,) {DO 1 , . 04 6 T c Stat 00 O EPA/Other- R LU State d. Z EPA/Other V J. Additional Descriptions for Materials Listed Above K. Handling Godes for Wastes Listed Above I (A) D015 0039 (A) 0040 W I { ) 001 039 { ) 10+40 a- 14' b 14. d. Q Z15. Special Handling Instructions and Additional Information' 4+0 0995721 6_0 04257286 00 F EMERGENCY RESP SOO-46 —1760 24HR Q Z = A 704 S S01 C D t— 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified,packed, Umarked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and national government regulations. If I am a large quanti 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 economical) � y y d racti able method of treatment store a or dis os 1 current) available to me which minimizes the present and future threat to human health V) practicable and that 1 have selected the p c g p Y and the environment;OR,if I am a small quantity generator,I have made a good faith�ffort to minimize my waste generation and select the best waste management method that is oe available to me and that I can afford. r O Printed/Ty d Name / Signature,,-r/ opth Day Y ar z tL T 17. Trans er 1 Acknowledgement of ReceiptVrMaterials t� R wA Printed/Type Namer---^ Signature Month ,,Zay Year R w S U_ 0 18. TronspoKer 2 Acknowled ement of Recei t of Materials 1 T Printed/Typed Name Signature Month Day Year LU E N R Q O 19. Discrepancy Indication Space Z F A C L 20. Facility Owner or Operator Certification of receipt of hazardous materials covered is manifest except as noted in Item 19. T Printed/[ypec(Name Signature fir} /Month Day Year �� (r t G ( s f t t✓ (C71 ^ l DO NOT WRITE BELOW THIS LINE. Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. DTSC 8022A (1/99) (Generators who submit hazardous waste for transport out-of-state, EPA 8700-22 produce completed copy of this copy and send to DTSC within 30 days.)