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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 EiK SHIP0 229494932 111111111111111111111111111111111111111 <br /> 0 0 7 1 1 8 5 0 7 S K S <br /> Please print or type. Form Approved.OMB No,2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number CAR000039370 2.Pagy of 31Em�Cq@y R4spggse Pl 9qg, 4.Manifest Tracking Number <br /> WASTE MANIFEST ZiVV ttJJ ``��f 11 [Ga 1007118507 SKS <br /> y 5.Generator's Name and Mailing AddressGenerator's Site Address(if different than mailing address) <br /> Escalon Preader Prands .r'Inc. <br /> 1905 hlchenry Ave <br /> ESCALON CA 95330-{)000 <br /> Generator's Phone: <br /> L 09--JJL----6OSI <br /> 6.7 r�spocfa�tCorttpanuAlame <br /> SYS EMS INC` U.S.EPA ID Number <br /> H1-tt�I TT V.Lttttl�`1I 3 TxFtiOOVOS120E <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> Ct_ef�� V��C M4-r� c-3 t 3-L-�,-L. <br /> 8.Designated Facility Name and Site Address S EETY-KLEEN SYSTEMS, INC. U.S.EPA ID Number <br /> 6000 88TH STREET <br /> * SACRAMENTO CA 95820 <br /> 916. 386-4913 CA000()I :1 <br /> Facility's Phone: <br /> ga 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit <br /> HM and Packing Group(if any)) No. Type Quantity Wt,/Vol. 13.Waste Codes <br /> NON-RCRA HAZARDOUS WASTE, LIQUID Ave G 13A <br /> 13: <br /> (AQ!JEOUS PARTE) WASHER SOLUTION) 0`� Dnp foo <br /> W <br /> W 2. <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional Informationr <br /> TSD: -SCA 811421{)9 ES12 <br /> 014 2{)1941 CSG: ?1 <br /> 24H EMEF{GENC`t#800-..468--1760-CH/SK/TFI.-.Conti,ac-t retained by Jen6e2tr'0at`*r co_Dfers a ency t�:;:sri y <br /> On initial. �tr anspor�ter 'to add or st.lb,5ti�tuk'e addi�tion.il �crans or�tears on genera ,oV , I e -1 if. <br /> 15. GENERATOR'S/OFFEROR'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 I am the Primary <br /> Exporter,I certify 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 262.27(a)(if I am a large quantity generator)or(b)(if I am a small quantity generator)is true. <br /> Generator's/Offeror's Printed/Typed Name Signat r Month Day Year <br /> S (d O <br /> 16.International Shipments <br /> ❑Import to U.S. ❑Export from U.S. Port of entry/exit: <br /> ? Transporter signature(for exports only): Date leaving U.S.: <br /> LU 17.Transporter Acknowledgment of Receipt of Materials <br /> � Tr sported Printed/Typed N e Si nature <br /> � Month Day Year <br /> a <br /> I b 10 1191 <br /> r 2 Print"d Name a Month Day Year <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space <br /> Quantity Type ❑Residue Partial Re'ection❑ / ❑Full Rejection <br /> ❑ <br /> Manifest Reference Number: <br /> F 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> LL Facility's Phone: <br /> W 187.Signature of Alternate Facility(or Generator) Month Day Year <br /> R <br /> Z <br /> F) 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> LIJ r� 1 HI 4 1 2' 3. 4. <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Si ature Month Day Year <br /> l <br /> EP F r pQ 2�(q�ev.17617) Previous a ions are obsol ESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM <br />
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