Laserfiche WebLink
c_ —0 0) <br /> D _ Zy- N cn <br /> Cl) SK SH i - O � w <br /> r+ cn <br /> Z we 0 N m <br /> Z 3'pe. 0 . <br /> UNIFORM RA7ARDOU5 t.Genaralor ID Nmm�a' form Approved,OMB Nn,2450-0039 O <br /> G7 WAS TE MANfPEST CAL60i�pr<r3'��;p 2.Pa4e of 3. me Re eP 4,Menlhll Trackin Number <br /> D -� � -� � 322 SKS rn <br /> I bene@tor'S Na a and Mari gddra55 O O ` n <br /> City 0f 7rat'y GeneraloPs S[le Atldeess it darerent than mallln ffiJJJ 1 0 <br /> D A9yydE' SVCLY• I gaddressi ( Q <br /> Z FR 'y 5pla Trac Blvd O cD <br /> C Generalor'sPhone_ X09-831-41?0 CA 5376-ii <br /> Mpg 0 0 <br /> = 57� CtN SYSTEMS INC <br /> U.S.EPAID Numhcr <br /> C/) 7"Poi mpanyNam. �Ai5'1r$$YlB1':'$i.", � CD <br /> CLEAN HARBORS ENVIROMIENTPIL SQt: INC. u,S.EFq Ia Namher C <br /> 8.Designated Facdity Name and Site <br /> CLEAN HARBORS ENV3'RONMFNTRL SERVICES, IN us pgiDNnnber <br /> IIMB 9 HIGHWAY 74 O <br /> Y.IMflfiC L 3 <br /> G Facility's Phone; 3�^i3S-4$12 NE 69145 <br /> 9a, ab.U.S.DOT Desairitron linctuding Proper Shrpp[ng Name,Hazard Glass,ID Number. � <br /> Hr,7 and Aacyana Group pFan ) 1e.ContainersN <br /> y) t1 Total 12.Unit r;,Waste Godes <br /> UN3375 WASTTSLH_f DS CONTRINING No Type Quantity wt Not. Q <br /> F'LQ01MAhLE LIQUID N.Q.5. (CiASQLINC, 1101 35p 0 <br /> BEIV"FNE), 4. 1, l II ' to <br /> trillz <br /> ua � <br /> c� <br /> ao• U1 <br /> ie F <br /> 3 <br /> _ 7 <br /> h <br /> O <br /> 14.Special Handiing 1--urws and Additional Information O <br /> 3S1):KP78Ii t17�" CIc3Fi j CS6. v <br /> V <br /> 1 t Eii81t 13;• rn <br /> -:4H EMEMiNCY#800-468—I760—CH/SK/i•FI—Contract retained by generator r:unfil a Rney author( N <br /> on initial tr ,n or r ad -additionala ah.1f i <br /> 15 GENERATOR'SIDFFEROR'S CERTIFICATION:i hereby declare that the contents of this consignment are fully and accurately described above by Me proper shipping name,and are of" <br /> ssill d,packaged. Ln <br /> marked and labeleWplacarded,and cts are in alf respein proper condition for transport according to applicable intemational and national governmental regulators IF asponshipment and 1 am the Primary 7Z <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent N <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 nm a smart guantily generator)is True. <br /> Generalo`;,'Offeror's Printed`Typed Name Signature Month Day Year v <br /> LA <br /> i. 0 <br /> 16.International Shipments , 0- <br /> ❑import to U.S. ❑Export from U.S. Pon of entrylexit: _-. Ln <br /> ? Transpoder signature(for exports only): Date leaving US.' G <br /> Xr177. ansporlerAcxnowfedgmenlofRerreiptofMaleerials rporter i Pnnfed+Typed NameSignature Month Day YearCIL <br /> rh <br /> Zoder2 PrinledfTyped Narr- Signature Month Day 'feai S <br /> O <br /> C <br /> 18.Discrepancy v <br /> 1&,Discrepancy Indication Spark II�� rn <br /> Type Residue ❑FarhatRejection ❑FullRejecllon Dq• <br /> fD <br /> Manifest Reference Number. Q- <br /> U,S.EPA lD Number Q <br /> i8r7A�e-��e;r=,.���tfiorGenerator) rp <br /> U � <br /> Faaays PAor1E, N <br /> O 1&Signalore of Aftemata Facility for Genteratorl Month Day Year N <br /> w <br /> a � <br /> z v <br /> y15 Hazardous waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) � -0 � <br /> n 1' 2' T__ <br /> 3 < O <br /> o 3 <br /> 20.Designated Facility Owner or Operator CelIff atibn of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Month Day Year G <br /> Pdn(ShcTyped Name Signature = � <br /> ni Foy/p� 1�j�Rl�ious editions are obsolete. GENERATOR'S INMAL COP <br /> m w <br /> O <br /> 0Fill -. .. <br />