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SSL SK SHIP# RiM47390 <br />Form Approve0. OMB No. 205OZ39 <br />FPA Form 8700-22 (Rev. 105) Prevlaus addlons are oosolate. <br />2) 775V135/8P8P4,� <br />Form deli nad for use an arts 12- itcR er. <br />1.aneNumber.PageEmergencyResponse176 <br />Rare1760NIFEST <br />HAZAROOU9 <br />HAZARDO000ID:48i <br />1 <br />1 -800-468— <br />���� <br />rs Name and Ma6hg AddressD <br />nofee. <br />TireN <br />Cherokee LnCR <br />95240-2401 <br />IsRpnx <br />rtar I CamW^Y Name <br />T%f?Vi1d00812ic�5 <br />SAFETY—KLEEN SYSTEMS, INC. <br />7. Tmnepwler 2 Camasm, Nemo NVIHUNMEN' <br />Nrallba <br />8. Gastgamd Fadllty Nome and Sea Aderees <br />CLEAN HARBORS EL QDRRDD <br />V f3MID Number <br />309 AMERICAN CIRCLE <br />EL DORADO 1 AR '11730 <br />RRD669748192 <br />870-8f,3-7173 <br />Fed PAone'. <br />6b. U.S. 007 Desmon (m ludlnp Pmpar Shipping Nems, Hazard Class, ID Nurow 10, Comektem <br />11.10121 12. UM <br />a W2* Codas <br />gs <br />H11 and Packing Gmup{deny)) No. 0 <br />Qwnuty WLML <br />41 <br />I <br />MIFF7 <br />1 y ! e <br />77y�`��4 J1 W�41If fail�ri as <br />�2,��D,7,"�'%� <br />VF <br />V <br />7 <br />s. <br />a. <br />u. spade) Narwmg lmwMwm ena Aamuo enxm TSD i EL B I 16849 <br />C3Ci 4 <br />FRIiiF171 q <br />4 HR E14ERGENLY #I--600-468-1760 (SfS / TFI) <br />i . G ERA n ER061'S E - ICA N: 1 wnlmtS Con mnenl are .yen ecaaetely aan e - �W"W m9 "'arts. and an tlesdAed, prkaged. <br />(0 ONO" for bempad aoatang to applxeble infemaWr of and mdonal govemwNI regulator. a expos 9110w end 1 am he Pdmay <br />marked and labobd'p!orArded, and ere in 80 MAP" proper <br />Expwltt. I cantly that the =taro of INS wl>signmq d wnrwm to the lams of he afladwd EPAAc)u m tdgmenl 01 Convent <br />I aert v that the waste minimisation s',etameni Ide-0-d M40 CFR 282.27(a) {III am a largo (uantty generator) ar (b) IN i am a smell qurNry <br />1 b sue. <br />81puNa t ., <br />GenerstoraltMemis PdnteNTyped Name �.. <br />i.. <br />_ N y nr <br />L <br />.� <br />16, Intimarlibnot Shipments Li Import to U.S. ❑FJgtad ran V.S. P1efdMY<m� <br />Trenspertw el9natum (ku expose arty): 00 WrArq U.S,; <br />17. TmeparterOdmdedgnenl of Receipt al Matariah <br />March DeY <br />Trey r 1 PnnladTYped NYur <br />spill <br />N <br />0 <br />yaZ <br />Manto Day Ypr <br />R <br />R <br />T r ype a <br />I108. <br />18. Dievepenq <br />ulwwffl ymdketbn Space Q Oualllty ❑TYPe ❑RIW. <br />❑Patdal Rot";m <br />❑Full Relecfbn <br />Man8eal Reianxe Nlmbec <br />IBt. Atbrnata Facility to,Ganeretor) ♦ <br />U.S. EPA ID NwMer <br />EI <br />LL FaditYs Phone <br />VMth Day <br />ac. grlure Alkmeta Fnalty tor Generator) <br />5g. �ei —us Westo Report Management Method Codes (I.a,Code* (OF rurdwe waste tWurnnl, disposal, and MgclVQ systems) <br />0 1 2 0 <br />4. <br />20. Des'snated Fediry Oun , or Operator Cart lmnen of receipt of hazamous maleMb wyered ty tra mrftt NOWas � In Item Its <br />1 nted ype Name nalure <br />sY art <br />rrmn:CZATr)Q'B INITIGI COPY <br />FPA Form 8700-22 (Rev. 105) Prevlaus addlons are oosolate. <br />2) 775V135/8P8P4,� <br />