Laserfiche WebLink
Font vad;;"qMB No:2fl5iMtt339 <br /> Please print Or Wok <br /> 2,f7ggs t o1 3,Emergaitcy Ftespanse h fi4arr est Trnaking Number <br /> UNII"QRM iiA A tpUtlS #; anera#+ii lD Number t4,€�X33"7 4 Ott JA <br /> • <br /> WR$TE MAt{! I»S7 '(800)X 2 -930€ <br /> 5;> ngratot s Name and Matlin9 Address eratW s sits Address{ii disrent than mailing address} <br /> � R Tate3 ( <br /> 11 <br /> CA <br /> Gerieratoi's C hOo U.B.EPA ID <br /> p•Transp*r 1 many Nama A C!2 8 2 7 7 0 3 <br /> WORLD OIL ENVIRONMENTAL SERVICES <br /> _ UA EPA 10 Number, <br /> 7.Tran5portar00mpgny Name A Q a} , <br /> Li�W go'OVE YSYSTEM INC, <br /> l.B,EPA 1p Nuinbar <br /> 8.Deaigttbff d Foolity Name 0 Site Address <br /> Y0 MANAGEMENT,INCIWO US HIGHWAY 96 <br /> '. <br /> YUMA <br /> Fodti s Phone: 9 <br /> ga Bb,U,B.A.OT0gscripttnrt(indudinq F'ropar5h p�n�Name,Hazard Class,ID Number, 1o:Containarg 19 Tofai t2.Unlit 13.Waste Gates <br /> HM <br /> and Pactsirg GriwP(6 00 Na. Type f3ugnttty tYt f+lol. <br /> 1•NOWRCRA HAZADOUS. ,VdASTE OLID(NON=CONI=ORC IN FILTERS) c 223 <br /> 0 <br /> �r <br /> 3.. <br /> 1�.SpaaN Hand}"srx�lnsi�u�t+=ons itiWiei tnfotmetion � <br /> IMMEI�ENGY.CC 3 TAt� C EI T EO 1400-424-9300 WOES TERMINAL *APPROPRIATE <br /> AI PROTECTIVE EQUIPMENT <br /> :EMERGENCY CONTACT CHEIk�7 SEC 6C}424 C()* T UC4� —. �� PROFILE �� : <br /> 15. GENERAft#R'y1t3FF 1tt}R'S CEC2Tf�lCATH7N I hereby Bed a <br /> that tlto cantants at#hia.cons annent era fury grid assttrstaty desobod abava by the propershipprr;g name,and are#a9sifred,P, ed. <br /> marital , tattons.tie. aht n#and t ren the t'mary. <br /> mxriced <br /> and=labalacarded,end.ono in o r`eapec la t> cond[don for hanepnrf aa�rdirx�Wilicabte�intemarotial and nauw+at�; regv <br /> pater,k certtfY#fret the etrntenis qE tuts ignrrdtnt o tOittt fo fem>s of the glxdsed Ep�iAcknoveedgrisant of Cott§ent. <br /> I setdfy that the waste�� lemeri#idantfC>ed 3t?-GER82.27( f I am lama quant ty gertatpr)or tb�(ifl.am g ematt quontitygeneratosl>s tntm. <br /> Ge etofisf'rrtypadNahts Bfgnatttsnth Day Year <br /> 1t 1 aicrial shlpraents importto t,S, t_t Exportfmm U.B. Flod—.Men W9. <br /> Transporter stgnatura(fortlls only): <br /> DA loothg,U.B.: <br /> 17.ItvrssparterActnorAad9mertpittscetptot Manth t)ay Yar <br /> ►— Trarispwter l t dhwftyped Nagar 5tgngture t ` <br /> } <br /> Sign to month payWod am <br /> ear <br /> 1$a aoGaascir Indlca4utr Sparx}' ❑ Elrypi£ ❑Residue. Pgt1l Fre <br /> C��liul�e�r; <br /> Mgnitsi f2efarenca Number <br /> U,S.EPAID Number <br /> 18b.Altemate Facildy(or Q** tor) <br /> faptltyef'tmrfe _ - _ whth. .Day Year <br /> 18c;-Signature otAttamate Fezyrty{or Garrarator) <br /> 19Hgzare Watsta vwpat Managarr nt Metlrod Codex(l.e.,aures f(r•hazardous waste treatment;dispc>sS,and raoyding eysteras} <br /> 2Q.,Ctastgnated Fear ' or Aparatar:Cerllrtca*in of receipt of hazer tpu§ti#a#ettals covet l by trig rrtmtlfast xcapt as Irt ttem i t3a <br /> yq <br /> gtgnature Y <br /> Pitittedffyped Name .. <br /> Ef�A Form 87oD 2z(R,v. <br /> 12-17)Previatrs edi# ns ars�bsr a#a. ESI A FACILITY O ER'A'S�•41�A IFEST SYR P Ei <br />