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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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SSL 5K SHIP# 232569317 1111111111111111111111111111111111111111 <br /> 0 0 7 7 2 4 6 1 5 S K S <br /> Please print or type. Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number CAR000039370 2.Pair 1 of 3.Er9r®t3 Be1p§nsrl"Ab 4.Manifest Tracking Number <br /> WASTE MANIFEST 1 4 /6V 1007724615 SKS <br /> 5.Generators Name and Mailing Address Generator's Site Address(if diRerent than mailing address) <br /> Escalon Premier Brands Inc. <br /> 1905 Mchenry Ave <br /> ESCALON CA 95320-0000 <br /> Generators Phone: 209-552•-6051 <br /> fi.ygXpft)(,DIVe &SYSTEMS INC U.S.EPA ID Number TXR000081205 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address SAFETY—KLEEN SYSTEMS, INC. U.S.EPA ID Number <br /> 6000 88TH STREET <br /> Facility's PhoneSACRAMENTO CA 95828 <br /> 916-386-4913 CA0000084517 <br /> '. <br /> 9a 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,0 Number, 10,Containers 11.Total 12.Unit <br /> HM and Packing Group(if any)) 13.Waste Codes <br /> No, Type Quantity Wt.Nol. <br /> NON-RCRA HAZARDOUS WASTE, LIQUID G 134 <br /> 0 (AQUEOUS PARTS WASHER SOLUTION) <br /> C) <br /> z 2. <br /> w <br /> 3. <br /> 4. <br /> --T <br /> 14.Special Handling Instructions and Additional Information TSD: SCA 84446101 E$12014 202044 CSG 21 <br /> abs"o \% k Z$CA <br /> 24H EMERGENCY#800-468-1760-CH/SK/TFI-Contract retained by generator confers a ency authorit <br /> on initial transporter to add or substitute additional trans ortEars on enera f. <br /> 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, <br /> marked and labeled/placarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations.If export shipment and am the Primary <br /> Exporter,I certtly that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. <br /> I certify that the waste minimization statement identified in 40 CFR 261(if I am a large quantity generator)or(b)(if I am a small quantity generator)is true. <br /> GeneratoeslOReror's Printedfryped Name Signature Month Day Year <br /> J 76.International Shipments <br /> F ❑Impod to U.5. ❑Export ham U.S. Port of entry/exit: <br /> = Transporter signature(for exports only). Date leaving U.S.: <br /> W 17.Transporter Acknowledgment of Receipt of Materials <br /> Tr rteri Printed/Typed N e Signa Month Day Year <br /> lit) 14W 101-0 <br /> i TransO Printed,Typed Name <br /> Q / �� nature ( Month Day Year <br /> ¢ ��'e's O/` �ZS 0 <br /> ♦ 18.Discrepancy <br /> 18a.Discrepancy Indication Space <br /> ❑ Quantity ❑Type ❑Residue ❑Partial Rejection F-1 Full Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> rai Facility's Phone: <br /> 18c Signature o/Alternate Facility(or Generator) <br /> Q Month Day Year <br /> Z <br /> N19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 1 H141 2. <br /> 3. q <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item Ise <br /> +III PrintteeedfTyp'eddd Name <br /> Sign re Month Day Year <br /> 20 <br /> EpA Form 8700-22 LRev.12-17) Previous editions are obsolete. L <br /> 1)14941/156023 DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM <br />
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