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7142 <br />Fnrm Aruumred. OMB No. 2D5f)-0039 <br />EPA t'ornn ism -a (Kev. h'revious etflilons are obsolete. DE81UNA1 V fA(:ILI 1Y 10 UES f INA.I IVN * I A I t (Ih Kr-kAulmr-u) <br />1)400056/40364314 <br />UNIFORM HAZARDOUS <br />i. Generator ID Number <br />2. Page 1 of <br />3. Emergency Response Phone <br />4. ManflesL TtacklnQ ambos <br />WASTE MANIFEST <br />CAD98234:3253 <br />1 <br />1--800-468--17...0 <br />fl <br />5. Gonerat W.W.. and Ming Address Generatoes SfteAddfess (ddftenl than maifmg arl�ess <br />SEARS .A/C 06791 <br />5.1.10. PACIFIC AVE <br />TOCKTON CA 950-07-6350 <br />Generator's Phone: <br />6. ransporler inpany Name U.S, EPA ID Number <br />SRF TY- -LEEN SYSTEMS, INC. TX9600050930 <br />7, Transporfer 2 Company Name U.S. EPA 10 Number <br />8, Designated Facility Name —andSN Address U.S. EPA ID Number <br />US ECOLOGY NEVADA <br />11 MILES S ()E' BEATTY HWY 95 <br />}3EATTY 4 NV 89003Faedity's <br />800--239--3943 NVT330010000 <br />Phone: <br />ga, <br />9b. U.S. DOT t)escr pton (including Proper Stopping Name, Hazard Class, ID Nurrrber, <br />10. containers <br />11. Trial <br />12. Unit <br />13. Wada Codes. <br />No. <br />Type <br />HM <br />and Packing Group (if any)) <br />Quantity <br />WIN01. <br />I. <br />NON RCRA HAZARDOUS WASTE: SOLID <br />DM <br />P <br />35? <br />(ABSORBENT AND OIL) <br />U <br />2. <br />w <br />c� <br />3. <br />4. <br />14. Special Harding Instructions and 1Wditional Information <br />SK S#iIPi2 S <br />370430 CSC�.n <br />+ HR EMERGENCY ik1-800-468--1760 (SAFETY-•KLEEN - 94138) <br />K AUTHORIZ .D.T0 RETAIN LICENSED SUBSEQUENT CARRIERS AS NECESSARY <br />1 . 0 S CERTIFICATION: t t;e * declare that the cadents of this consignment are fully and aomtelp described above by the proper sNppbtg Mme, and ara r"Acct, pd�dteged; . <br />marked and.labeled+placarded, and are to all respects in proper condition for transport aeconAng to applobie rite nationat and na tatat goveromentai regrdatens. w export sNpmem and I am the Primary <br />Exporter, certify that the contents of AtEs consignment conform to the terms of the attached EPAAcknowledg L <br />.! <br />I. "kthat the waste. mlnhnIzatIgQ statement idenlified'm 40 CFR 282.27(a) (81 am a large quantity germrata) ( (d t am a small qua rotor) is true. <br />ne tq ', eroes P46tedrryrnedy eaz <br />es <br />Iritemauo I Shipment Import to U.S. ❑Export from U.S. Pod of alaxt :— <br />Tran rtersi nature orex sonl Datelesvi U.S: <br />17. TransporlefAdm wiedgmentof Receiptof Materials <br />Trans Printed/Typed . re y ear <br />_....�- r <br />o. <br />tea/r <br />Tran poder 2 PrintedlType Name y <br />18. Discrepancy <br />18a. Discrepancy Indication Space ❑ Quanety ❑Type [:].Residue ®Padel Rejection ❑ o.Rejeclron <br />Infest Reference Number: <br />18b- Alternate Facility (or Generator) U.S. EPA ID Number <br />V <br />Fac1i s Phone: <br />18c. Signature ofAltematefarapty (or Generator) Month Day Year <br />4 <br />Z <br />019, <br />Hazardous Waste Report Management Method Codes (i.e., codes for hazardouswaste treatment, dlVMI. and recyding systems) <br />� <br />1 <br />2. <br />3. <br />4. <br />132, <br />20, Designated Facifity Owner or Operator: Cerblicaton of receipt of hazardous materials covered by the manifest except as noted in item 18a <br />PrintedYew <br />ffyped Name Day <br />F <br />EPA t'ornn ism -a (Kev. h'revious etflilons are obsolete. DE81UNA1 V fA(:ILI 1Y 10 UES f INA.I IVN * I A I t (Ih Kr-kAulmr-u) <br />1)400056/40364314 <br />