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State Hazardous Waste �� D' <br /> STATE AND FEDERAL LAW PROHIBITS IMPROPER DISPOSAL It <br /> F FOUND.COHTAC-THE NEAREST POLICE OR PUBLIC SAFETY AUTHORITY.OR THE U.S. <br /> ENVIROIA•ENTAL PROTECT"AGENCY.OR THE APPROPRIATE STA IE AGENCY. <br /> General.,Name: NO Supply Construction Supply.I.W. <br /> 'IDS Lopelion 10: CA304A NEOUESrFOIL BAGGED ROODS eECYNt1G <br /> ;.dd•ess: 1166 S Wilson Way ....-__.._.. BRnsh Man .-- <br /> Cry.Stas,LV. Stockton.CA,95205 Bandit f:DYC &anrh Address wl.;A <br /> EPA ID No,: CAROOOIV692 __....3_ IIW,S.66."0-3 LA A-1 <br /> late- uuclereJ G 45'2eG DEA: l2o�ee 5wr.,.r•ao <br /> P-oduct Nam¢ SOLS PAIL CLASSIC GRAY HARDENER LM SCOFIELO <br /> NamS <br /> " e0.ProNe NP RCRA H scemao,Said Product Na ,SMI' Capes T OdElrul fnrrtalner f of Cyrner fmdNbn of Med— <br /> Pani Product Ta.., <br /> .mpinara 4arsw.am,o.Pap <br /> PMalw slate: saM i N,w,N4 wayM <br /> —.._ <br /> Cadairrorr2orie. vHbw Te9-J <br /> Wafw Compost- Noo-RCRA Hauisos Waste Saw.P—aany Tu,—Aouadc Arcw_3•+aeT14 gr—*Z-K- SDIIs aAe- 1 _ <br /> and Hs arcs Life. _ <br /> to 12.'Sw 4aa1v]o yoln r <br /> Sun Doha of 34JUN-ZO <br /> Accurm,muon also av 4rtSlrsaa Sora 3 <br /> Ownu,.t Piquat W. McLsa[,5 er zf7..o.Tfa $alb .. <br /> 1. <br /> ,)K 21iAA.D trOO1�_, S <br /> DEA Sgnarum: - •' 4.06, AJ -193-1gb4k. SOIb -7 <br /> Conn— -Nv 1 m?,,ITn•I 41r11b ? <br /> S. gcllb 2- <br /> ro: Jtl fa <br /> 1—,ao7wst.A3r7 ;3J•fcH�l <br /> H�/DJ1I1sIN1 c«,w:iar a�jll•I1pIl DGooDNzsa36 <br /> 74P5 4331iSrfw (Mlle 3 <br /> 1111111II�II�IIIIIIII IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII IIII I) III 51c Mr'4um 2ee��o 9"h <br /> `a'it,iii zoo tS5.5.-r�-� So lta 3 <br /> ao swmY viawknn a m.roemui <br /> 1 <br /> KLEEN <br /> /ndu.!is/Servfcea <br /> 500nk Can 5�a:2,a C::15:-32 2 <br /> CA..a <br /> 1LAN CA RANCHO CUCAMONGA CA-HAYYIAgD A PORT UR TACOMA WA <br /> 16191427.4]11 f� (9p9)9a1-40]6 '1800 2]]1134 (600163n BAg9 1600)226-1166 <br /> �_.___,,,, 411 2100 1(5031.226-3965_❑ (253383 2168 L.�, <br /> STATEMENT OF WASTE DESIGNATION BILL TO PROJECT ADDRESS SHIP TO <br /> __.._ <br /> Representative <br /> forthsamples;were <br /> 40 CFR pill 281 for hazardous tested n <br /> wes a character tia ioneparametersdance w,th <br /> and ds gnalio,Accoohog 10 40 <br /> CFR part 26211 12)and based on specific generator knowledge of this material.supporting <br /> documentation provided from analytical laboratory analysis.review of applicable Material Safety <br /> Date Sheets and other supporting documentation.the Generales has deagneted this materal as 1 <br /> (check one) AtXKUHT No aPEduLi<lmx:rE+ris ._ -- -- <br /> BOER pA1L S4wPurG nA1E LLUe-pnEP JnnEn Np Mi rrng—Nuumi, <br /> . <br /> ❑ <br /> Non-RCRA ERM(25143.2) Non-Hazardouf� Pgpg1DT CODE v'� TTs� nE Est rou I VNRPRKZ AUOtMT <br /> I earthy that all Informal—submitted in this Statement of Woste Design—and af—had —' <br /> documents are,to the best of my knowledge and belief,complete and acchrole,arc that a%known or <br /> suspected hazards have been disclosed per California Title 22.pan 66200.200. <br /> SFO-19-239 STOCKTON <br /> Project Number Pro)eet Name — ---- - <br /> _._ <br /> HDSUPPLY 1166 SOUTH WILSON WAY,STOCKTON,CA 95205 �Nw nm Owa epwaAa.aA wAew eRMmWd vop.m ua ace prey has.`,51432). q.RA ePw9 <br /> MAaagbnu was.. NtErt a4Uk21 A wAaw�upq YmwWa Program <br /> ..... ___—_.—.._..__ <br /> Adtlreff CUSTOMER BVI"AIS ALL R/SIf9 ANO LIABILITIES WNEN IlalNO JUMBO BAOS <br /> Company ALL RL'VSED JUMBO BAGS MUST BE COMPLLTELYTIEO ANO IX-- <br /> "I.0 W/IFI NO RIPS OR TFAR9 <br /> 11/8/19 gEAAu FOq EXCESf TMF: - <br /> J/' ROGER SCHIAA_,ST.P_.._GER <br /> A1Rhor ed 9lgnature Print Name T1t1 late '- <br /> 10—alar.—E. <br /> To AL UNLonpind - <br /> ___ _ T— <br /> nOrkY .... WEIGHT TARE YIEIOHT NET WEKDiT <br /> THANK YOU FOR YOUR OROERI <br /> RECEIVED By. <br /> X DATE <br /> CUSTOA:_�-- - <br /> -; .!_i/ A, <br /> 1 <br />