COMPLIANCE INFO_2020 - Laserfiche WebLink

Home Browse Search

SSL 5K SHIP# 229483948 t1.: Please print or type. Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS tBr1e"at0r ID Number 2.Page 1 of 3. me�g�pp Rp�se A.Man(if�estTrackinNmberSKS c WASTE MANIFEST CAL000043752 t'lttn0 Rt7CF— 0) a V ac V KV �5.Ge eratods Name and Mailing Address Generatoes Site Address('d different than mailing address} -Df Tracy Bo de Svetr . 520 Tracy Blvd TRACY CA 95376-0000 Generator's Phone: 1209-831_4120 6.Trff�rl.Coit`tI p N SYSTEMS I NE � U.S.EPA ID Number T X ROMOS 1 r205 7.Transporterl2 Company Name U.S.EPA ID Number ._CLEAN HARBORS ENV SUC INC. >MAD039322250 8.Designated Facility Name and Site Address CLEAN HARBORS ENVIRONMENTAL SERVICES, IN U.S.EPA ID Number 2247 S HIGHWAY 71 r r KIMBALL , NE69145 . 308-235-401 NED981723513 Facility's Phone: 9b.U.S.DOT Description(inotuding Proper Shipping Name,Hazard Class,ll)Number, 10.Containers 11,Total 12.Unit 13.Waste Codes Hca and Packing Group(if any)) No. Type Quantity M.NDI. 1 NON RCRA WASTE LIQUIDS DFM � t� R 343 o , (D ESEL), LU z 2. LU t9 3. 4. 14'.Special Handling Instructions and Additional Information 'T ED i KP 81043056 C123277 CSG: G� �� T 244 EIMERGENCY#800-469-1760--CH/SK/TFI-Contract retained by generator confers agency y authori y on initial 15. GENERATOR'SIOFFEROR'S 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, marked and labeledlplacamed,and are in all respects in proper condition for transport according to applicable international and national governmental regulations.If export shipment and I am the Primary Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. 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 ama uantity generator)is true. GeneratoesfOfferor's Printed/Typed Name ignature Day Year 16.Intemational Shipments F ❑Import to U.S. ❑Export from U.S. Port of entrylexit: ? Transporter signature(for exports only): Date leaving U.S.: CC 17.Transporter Acknowledgment of Receipt of Materials Tra porter 1 P-ntedfryped Name Signatu M th Day Year a Z Trans Print�ypedName th Jay Year 18.Discrepancy 18a,Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number. 181b.Alternate Facility(or Generator) U.S.EPA ID Number -Q J LL FaciRy's Phone. Month Day Year W 18c.Signature of Alternate Facility(or Generator) a Z 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) � 1. !� 2. i fU, 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in hem 18a PrintedlTyped Name igrratu(e Month Day Y ar EPA Form 8700-22Rev.12-17)} Pre sous editionsare obsolete. DESIGNATED FACILITY TO GENERATOR 1)8695488/1897743