Laserfiche WebLink
z7-0 0055236875 K5 <br /> Please print or type.(Form designed for use on elite(12-pitch)typewriter. Farm Approved.OMB No.2050.0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 12.P 1 of Ey- se4.ManifestTrackin #lumber8 7 SKS <br /> CAL000375509 ' ' 0 0 5 5 3 6 <br /> WASTE MANIFEST <br /> 5.lbratpr'ss N mg pu Mail g Ad¢CeQu [1�. General Site Address(if different Shan mailing address) <br /> (8830 W ttL��i n IEn]a Rd <br /> TRACY CA 95304--9109 <br /> Generators Phone: 209-836--0955 <br /> "SA"E"If1-2",TNO SYSTEMS INC. U.S,EPA ID Number <br /> SYSTEMS, TXR000081205 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 6,Designated Facility Name and Site Address CLEAN HARBORS BUTTONW I LL0 , C U-S.EPA ID Number <br /> E500 LOKERN ROAD <br /> BUTTONW I LLQW CA 93206 <br /> 551-752-6L 00 CAD980675276 <br /> Facility's Phone. <br /> 9a_ 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Centaine"s 11.Total 12.Unit <br /> HM and Packing Group(if any)) No, Type Quantity Wt,lVol, 13,Waste Codes <br /> 1- NON RCRA HAZARDOUS TASTE o SOLIDS (SPIL rJt>( IQ P =s52 �L CLEANUP NO FREE LiOUIDS ; � <br /> RAGS/POLYPROPYLENE/DEBRIS OIL) I <br /> z 2. <br /> u� <br /> 3- <br /> 4. <br /> 14.Special Handling Instructions and Additonal Information TSD.-BL 7134-5917 <br /> 4 HR EMERGENCY #1-300—+68-1760 (SSS I TFI) <br /> AUTH AS "AGENT—FOR" BY 13EN TO RETAIN LICENSED SUIS CARRIERS AS NECESSARY <br /> 15, GENERATORWOFFEROR'5 CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, <br /> marked and Iabeledlplacarded,and are in all respects in proper condition for transport according to appl cable internationala national governmental regulations.If export shipment and I am the Pnmary <br /> Exporter,I certify that the contents of this coosignmem conform to the terms of the attached EPA Acknowledgment of Conse . <br /> I certify that the waste minimization statement identified in 40 CFR 262.27{a}(if I am a large quantity generator)or(b){if I aa small quantity gaperaior)is true, <br /> Generator'slOfferors Pdntedfryped Name Signature Month Day Year <br /> 16.IntemationalShipments <br /> Import to U.S- ❑Export from U.S. of elTransperter signature(for exports only): - -- <br /> Dateleaving U.S.: <br /> w 17.Transporter Acknowledgment of Receipt of Materials <br /> iiTrans 1 PrintedrTyped Name n Mon Day Year <br /> 0606 <br /> A�E y Al i <br /> a Transporter 2 P intedlTyped Name Signature Month Day Year <br /> W <br /> F <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space <br /> ❑ Quantity ❑Type ❑Residue ❑PaNal Rejection ❑Full Rejection <br /> 18b.Alternate Facility Reference Number:lity{cr Generator} U.S.EPA!D Number <br /> V <br /> LL Facility's Phone: <br /> W 18c.Signature'ofAitemate Facility(or Generator) Month Day <br /> H <br /> 19.Hazardous Wast e Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 1113R— 2 3 4 <br /> 20.Designated Facility e r Operator:Certification of receipt azardous materials covefed by the manifest except as noted in Item 18a <br /> PrintedlTyped Name Signature Month Day <br /> lr �r <br /> 1---- <br /> EPff"f�4Br�2 p�.��.�.p s editions are obsolete. <br /> ,s�xF ;`af�DTu DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />