Laserfiche WebLink
SC. 00644- '41014 <br />r <br />>i )00o koto 2) if V71 Q405.0094 `J <br />1).2196 380%'369498-9976 <br />pn a Iy� ( ,ori <br />a for use on elfte (11 2 -pitch) typewriter.) For, Approved. OMMo. 2050.0039 <br />UNIFORM HAZARDOUS <br />1. ID Number <br />CAD982343253 <br />2. Page 1 of <br />i . <br />3 EmergMY Response phone <br />` <br />4. Manifest Tracking Number <br />1001216840SKSr"'E'•(IR <br />•V ASTANIFEST <br />1-800-18— <br />5. s Name fend Nailing Address GenaneWs Site Address (f different than mailing address) <br />SEARS B S= 01288 ` <br />BOX STORE <br />5110 PA�IFIC AVENUE <br />STOCKTON CA 95207 <br />GeneratorsPhone: 209-477-8111 <br />"hMIRWSYSTEMS, INC. U.S. EPA ID Number TXRO00050930 <br />7. Transporter 2 Company Name U.S. EPA ID Number <br />% ./ <br />B. Designated Facility Name and Site Aildree <br />/ SAFETY-KLEEN SYSTEMS, INC. 000616 U.S. EPA ID Number <br />1722 COOPER CREEK ROAD <br />DENTON, TX 75208 <br />'.940-483— 204 TXD077603371 <br />Facility's Phone: 14 <br />ga <br />9b. U.S. DOT Desaiptbn•(induding Proper Shipping Name, Huard Class, ID Number, <br />10. Containers <br />11. Tont <br />. �... <br />12. Unit, <br />'•' ' 13. Waste Codes <br />No. <br />Type <br />HM <br />and Pig yup (ifeny)) <br />Quantity <br />WtJVol. <br />X'1- <br />RQ HASTE FL LE LIQUIDS, N. 0. S. <br />DPI <br />P <br />D00 DOO8 D018 <br />(GASOLINE) . <br />213OUTS <br />. <br />q <br />3 UN1993 PG II (DO18,D001) <br />Z <br />2. <br />W <br />- ANI <br />3 <br />r Ft <br />�- <br />4. <br />f4—.Special Harding lnftcfims and Adfifional Information NPK TRCKS109506269 :--j.;0001986801 <br />1)ERG0128 <br />SK AUTH'D TO USE SIMSEQUEN2 C RS 8 <br />15. GENERATOW51OFFEROR'S CERTIFICATION: i hereby declare that the contents of the consignment are fully and accurately described above by the proper shipping name, end are classified, packaged, <br />marked and labeledfpacarded, and are in all respects in proper condition for transport according fe applicable informational and national governmental regulations. If export shipment and I am the Primary u <br />Exporter, I certify Gnat the contents of this consignment conform to the terns of the attached EPA Admowledgment of Consent. s <br />I car* that the waste minimization statement entified in 40 CFR 262.27(a) (If I am a large quantity generator) or (b) (If l am a wall quantity generator) is true. <br />wslofferoes Printedf yped NacreDay Year <br />"e Z 'R P, 7r!' w �7 P �® <br />� <br />P. In I shipments <br />� ❑ Impart to U.S. ❑ Export U.S. Port of entry/exit;. <br />= <br />Transpoiter signature (fa exports only): Dae leaving U.S.: <br />w <br />17. T of Pt of Materials <br />T r 1 yped Signature Month Day '.Year <br />co <br />I�Tnt <br />4 <br />2 PrknedRyped NAMe/ re Nfontli Day Year <br />18. Disaeparncy <br />18a. Discrepancy indication Space ❑ Quantity ❑ Type ❑ Residue . ❑ pe a1 Rejection ❑ Full Rejection <br />Manifest Reference Number: <br />18b. Alternate Facr'tily (a Generator) U.S. EPA ID Number <br />3 <br />V <br />ra+ <br />Faclfitys Phone: <br />W <br />18c. Signature of Alternate Facility (a Generate) <br />Month Day Year <br />19. Hazardous Waste Report Management Method Codes (Le., codes for hazardous waste treatment, disposal, and recycling systems) <br />o <br />f ffita <br />2. <br />3. <br />20. Designated FagkfOwrq or of receipt of hazardous materials covered by the manifest except gpoled in Item 1 <br />Printef/iyped a nature . Day <br />EPA <br />Form 870 ev.3.051 Prevklusadre sdete. GN E A I V TO GEN OR STATE 1IF REOUIRE®1 <br />>i )00o koto 2) if V71 Q405.0094 `J <br />1).2196 380%'369498-9976 <br />