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COMPLIANCE INFO_2021
Environmental Health - Public
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EHD Program Facility Records by Street Name
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2200 - Hazardous Waste Program
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PR0517881
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COMPLIANCE INFO_2021
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Entry Properties
Last modified
11/10/2021 11:42:57 AM
Creation date
9/13/2021 12:52:28 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2200 - Hazardous Waste Program
File Section
COMPLIANCE INFO
FileName_PostFix
2021
RECORD_ID
PR0517881
PE
2226
FACILITY_ID
FA0004254
FACILITY_NAME
ESCALON PREMIER BRANDS
STREET_NUMBER
1905
Direction
S
STREET_NAME
MCHENRY
STREET_TYPE
AVE
City
ESCALON
Zip
95320
APN
22514059
CURRENT_STATUS
01
SITE_LOCATION
1905 S MCHENRY AVE
P_LOCATION
06
P_DISTRICT
005
QC Status
Approved
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SJGOV\gmartinez
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EHD - Public
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����U��IIIIIII�IIIINhIIIIKISS11111 <br /> SSL �rK SHIP# 224141834 Form Approved.OMBNo.2050-0039 <br /> R �O�BO 4.Man9eslTneckln9Numher 41 SKS <br /> Please print or type. 2.Page11 of 31EmaCgirlDY _i b 0071 0 4 5 <br /> UNIFORM HAZARDOUS <br /> 1.Generator lO Number CAR040034370 t3S�V1VV <br /> WASTE MANIFEST Generetols Site 1 dress(if different man mailing address) <br /> 5 G memee,Name and Mailing Address <br /> EScalOn Premier 1lrands Inc' CA 45320-0044 <br /> 1905 k1chenry Ave <br /> ESCALON U.S.EPA ID Number 20S <br /> 209-5��2--6451 YXROOOU*si�:.c�= <br /> Generators Phone'. ',� <br /> U.S.EPAIDNumber <br /> NM 46 j3c) <br /> 7.Transporter 2 Company Name �� U.S.EPA ID Number <br /> C L +� <br /> e.Design Name SAFETY-KLEEN SYSTEMS INC. <br /> 6404 88TH STREET CA 4828 CA004Utf0i 1' <br /> SACRAMENTO <br /> 416-386-4413 <br /> Facility's Phone: 0.Containers 11.Total 12,Unit 13.Waste Codas <br /> 9b.U.S.DOT Description(including Proper SM1ipping Name,Hazard Class,ID Number, No. <br /> Type Ouantiry Wt.Not. <br /> HM and Packing Group(if any)) G 134 <br /> ( <br /> 1At3UE0US PARTS WASHERSUT <br /> SDLION) <br /> cD Q� 411h <br /> z <br /> r <br /> z <br /> 2 <br /> W <br /> i <br /> 3. <br /> 4, <br /> 84772435 ES12014 201935 CSG: <br /> 14.Special Handling Instructions and Addidonal Information TSD: SCA <br /> 24H EMERGENCYii800-468-17b4-468 —Contract retained by �enneeraator confers agency <br /> ar�thari y <br /> r sMPDi^9 name,aN are classified packspad,f <br /> 150.nGENERA OR'SIOFF ROR'S CERTIFICATION: hereby declare that the contents of m'ior suts cons gnment�r N Y and accurately ddescribed above by me propeOn e n rotor l Or am b <br /> marked and RISJOFFERerded,and are in all respects in prober condition fa transport according to applicable Inte tonal and national governmental regulations.If export shipment and 1 am me Primary <br /> rf tam a large quantity generator)or O(d I am a small quantity generator)Is true. Marih Day Year <br /> Exporter, telly that the contents of this consignment conform to me terms of the attached EPAAcknowledgmenl Consent. <br /> I caddy that me waste minimization statement identified in 40 CFR 262.27(8)(' Signature on 4 1 q <br /> Generators) es Print dlryped Name - <br /> A1�A\eY, ❑Export from Us. Port of entryleuC <br /> 16.International prems ❑Import to U.S. Date leaving U.S.: <br /> 3 Transporter signature(for exports only): Month ^Da(y- Y1epar <br /> W <br /> 17.Transporter Acknowledgment of Receipt of Materials Signature OZT Pv l l <br /> K C T 1-P`dntedRYPMonUU Da Year <br /> 01 3(� 1 <br /> rad adRyped Name <br /> ♦1 18.Discrepancy ❑Residue ❑Partial Rejection Full Rejection <br /> 1 ills.Discrepancy Indication Space Quantity E]Type <br /> IMandesl Reference Number: U.S.EPA ID Number <br /> Iflo Alternate Facility(or Generator) <br /> Month Day Year <br /> Facility's Phone: <br /> lgc.Signature Of Altemate Facility(or Generator) <br /> Z19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 4 <br /> 3. <br /> 2. <br /> 0 1 H141 <br /> rag.Designated Facility Owner or Operamc Celfication opt of hazardous materials covered by me m5ignature pl as n i ` <br /> t exMonth Day Year <br /> E <br /> 1 Prinledlfyl) ^/ (� 7 PAf r g -2y(ggee .1 1) Previous editions areobsolele. DESIGNATED CIL 0 EPA's e•MANIFEST SYST M <br /> /15�0�-� <br />
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