HomeMy WebLinkAboutDSHW-2025-001398UTAH SUREAU OF F{AZA.D.D3US WASTE YAI'JAGEM=I.IT
UNi FCRM lrAZ ARDOLJS I\'ASTE MANjFEST CH:CKL iST
Tn:.s crecklist, is iesi-oned tc assis',- Sureau cf PezaiCcus i{aste personnel
evaluate'.-he cc;;ieieness cf tFre nanifests. It is nc'u a su=stiiute fcrihe :e-cula'uions. (See Part IV of the Ui-rwMR for ccm:lete requi.re;aents).
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1. Geneiator t s U. S. EPA ID Number/
Y€nr f es t Docurir3nt Number ,lfi Y Y
2. Nunrgr of Daoes ?/Y
3. Generatcr's Name and Mailino Address Y V Y
4.Geneiatcr t s hone Number Y V Y
5. TransDorte! L Comcanv Name Y /V
6. U. S. EPA ID{I cf Transoorter I v Y
7. TransDorter 2 Ccmcanv Nane yi it/fr
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8.U.S. EPA IH, of TransDorter 2 Nt*Y
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9 . Des j. onateC Fa: j.Li tv Nane and Site Acjdres ,Y Y
J 0. U. S. EPA I D{/ o f Des ionated Facilit v VI
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ioned lor utc on clite (12-oitchl typarvritrr.l .Form Approvad. OMB No. 2O5O-0O39. Expires 9-30-91
UNIFORM HAZARDOUS
WASTE MANIFEST
l. Generolor's US EPA lD No.--. ggz 591 .050.
Monif estosz"trs$:2. Poge I
of1
ln{ormotion in the shoded oreos isnol required by Federol low.
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3. Gcnrroror'sNomeoadMoilineAddrcs ChemiCal Handling COfp.
PO Box 1044111811 Upham SBroomfield, CO 80038l. Gcncroto/rPhonc( 303 450-1 000
t A. Stote Monifesl Document Number
B. Stote Gcncrotor's lD
5.6. US EPA lD Number
Er"p. 9.8 1 tr 9.5 .7 20.
Tronspoder I Compony Nome
CoaI City Cob Co.
C. Stote Tronsporter'r lD 4 1 0 1 5
D. Tronrporter's Phone I 1 5 I 63 4 - 47 7 3
7. Tronrportet 2 Compony Nomc US EPA lD Number8.
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E. Stote Tronsporler's lD
t. Tronrporter's Phone
9. Designoted Focility Nomc ond Sitc Address
Systech EnvironmentalSo. Cement P1ant Rd.Fredonia, KS 667 36
10. US EPA lD Number
I rsD 9Bo G.33 zss
G. Stote Focility's lD
KS81 001
H. Focility's Phone
3151379-4451
ll.US DOT Dercription (lncluding Proper Shipping Name, Hazard C/ass and lD Number)
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12. Contoiners
No. I trr.
13.
Totol
Quontity
14.
UnitWt/ Vol
t.Woste No."r RQ Waste FLA!,IMABLE LfQUfD N.O.S.
FLAMI,IABLE LTQUTD NA1 9 9 3 FO 03 / FO 05 Innol 0.0.1 T.T 6 0 0 G
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J.Additionol Dcrcriptionr for Motcrioh U$cd Abovc
.an
(. Hondling Codes for Wostes lisled Abovc
t5. SpcciolllondlinslnrduaionroadAdd$onol lnfo,rmotion fN CASE Of EMERGENCY OR ACCfDENTAL SPILL OP RQ,CoNTACT R. A. MELTCHAR, 3031460-1000. THrs MANTTEST CONSTSTS OF THE POLLOWING MANIEEST OOCUUUUT #s: 305088, 10391; 10392; 103g3; 11089i 12374; 31102lllOt; gtg06, 31706; 3 ; 31708; 31801; 31802; 31804; 31810 coNt BLocK 19
mArd. ond bbdrd. cod on ia ol rcpe<tr h prcprr ccnditbr lor trcnrpcrr hy highroy octording to opplkobb inrrmcrirmol ond mrinol goy..m6lol ,.gelofionr.
lllomolorgrquonritygrnrroror,lcrdlythotlhonoprogroninyxrtcrdxrthrvoluncondtoriGitroluort.g.n.rot droth.d.g.Glhovrdrr]ninrdtoboxmcmicollyprocticoblc
Ol, il I cn o moll qwntily erm.clq.lhcvr mdr o good loi$.llorilooiritrrir. mtr wort. g.o.rsrio ond rkt rrf'6!l rorl. Domg.mcnt mrthod thot irovailobhbmr ond thot I <on
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1gl frintcdllygcd Nomrr trohfr/^Pbl*fiff* R. A. r,terichar "'fY_fiN fu fff,ial?i
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lT..Tronpoacr I Aclnowlcdgcmcnr ol Roccipt of l$otcriolr V A/ Ar/dZ 4 e.A I
J e;ntod/Ty1ed Nomer x t I ll / vrilltlrtit John Applegat "lct
sfnoru'e:tr1
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18. Tronrporter 2 Acknowlcdgerncnt ol Rcccipt of AAororiolr
Printcd/Typcd Nomc Signolure / Monlh Dov Yeottrt
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re. Discrcponcy lndicorion spoce 3181 8; 31 820; 31 9 02i 31 908-;291095. furu€r 5tut€s qtray/rafrb llDo Pou,t8ail'4& 1s67pd n rsu/ihr.
291 092 i 291 09 4;lh!frt. ttil7n-101091 i 291090;o€ "/u#, /e/f oA
20. focility orrnor or Opcrotor: C.rliliaotion ol rocdpt ol ho:ordout motoriolr covcrod by thir monilcrt.rcrpt or notcd in ltcm 19.
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7 -BLC-M5ORIGINAL RE U RT.I TO GE N E RA tOR