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'71 <br /> MPS <br /> Pot pen or type,(Form designed for use on elite(12-pitch)typWForm Approveaft 2050-0039 <br /> riter.) a-T king Number. <br /> Generate ID Number 2.Page I of 3.Emer _cy R7onso Phone 14.Me a Trac <br /> 1 .1 13 <br /> HAZARDOUS 76 <br /> UNIFORM HAZAR 1-2444943-min"i'l ft.- M] -4 8 '1', <br /> WASTE CA09&t(Jqj82dr-_ I 0035r'33191 FLE <br /> 5 _W ��A Iny, Grerators, to Address(if different than mating address) <br /> .General Name and MaIlIng Address .'� 6 <br /> ...MERGERS&.-B&M—w-forlt"m �Ijl 10 <br /> +J" ' 11;7- <br /> W /yam <br /> # [,4- <br /> GeneratoesPhone: U.S.EPA ID Number <br /> 6,Trans pra <br /> ME <br /> 0T,(T VarneN 9,Y )TEAS, TNG. TY <br /> K EU <br /> 7.Transporter 2 Company Nam U.S.EfiAll)Number <br /> -fo—eqnated Facility Nam—and Site Address. SAFETY­KLEEN sys,rusp INC. ..DNumber <br /> 6000 BOTH STREET <br /> SACRAMENTO CA 95828 CA00000845t7 <br /> 916-386-4913 <br /> FwMWs Phone: it.Tt.1— 12.Unit <br /> go. 9b.U:S.DOT Description(Including Proper Shipping Name,Hazard Class,ID Number, 13.Waste Codes <br /> HM and pact ira Group(d any)) No. Type Qua" Wtivol. <br /> T. NOW-RCRA HAZARDOUS WASTEj LIQUID DM 04 <br /> (AQUEOUS PARTS WASHER SOLUT10H) <br /> UJ <br /> 2. <br /> A <br /> 3. <br /> 4.' <br /> 14.Special HiMng Instruclibris andAddiflonal inibimation <br /> 31( 9ff1P#WQ44&--aV'53467109 361147 201114 CS6:25, <br /> A; <br /> 24 HR EMERGENCY ft�-800-468-1760 (SAFETY-KLEEN -.1CONTRACT #94138) <br /> Sit AIIT!4nR 7E0 TOIRFTAlki 11-TCERM 'FlUBSE61JENT CABRIM-1 AS N CESSARY <br /> 15. 'GENERA . - of this consignment a fatty d atel,y described. above by the pper shipping name,and are dassified,padded, <br /> .T,0111810IFFEROR'S CERTIMATION: I hereby declare that ft donterb re ful an accun <br /> marked and laboi ond wqM accaft to appi international and national governmental regulations.it export shipment and 1.am the Primary <br /> O#Iaor4gd;aod.aTinstro�inpmpere Men for m cable <br /> Exporter,I certify that thi oarhtents of ft consignment conform is the teens of the alftiched EPAAciviewledgawt of Consent. <br /> ljoerely thel the waste minimization statement itkinlifled in 40 CFR 26221(a)(if tam a large quantity generator)or(b)(d I am,a small quantity generator)is true. 3ar <br /> Ge"FaloesiWeWs fttWffypW Name 77 77 <br /> 'ry <br /> P-*- HExport from U.S. poftblentry/e* <br /> Mort to U.S. 090 leaving U.S:: <br /> 1t n s. mature fore ord4; <br /> Transporter Acknowledgment of Receipt of <br /> ransportSignature Month Day Year <br /> wd Name, <br /> 0 <br /> Month Day Year <br /> 1TrsnsWer2printodfTypedN me <br /> IS.Discrepanq TjFull Rejection <br /> ouentity El Type ❑Residue hitlel Rejection <br /> I Be.Discrepancy Indication Space <br /> Maoilest Reference Number. <br /> 4ab.Aftem*e!Facft(or Generator) U.S.MA ID Number <br /> IL. Fadhes Phone: -Month Day Year <br /> Uj 18c—Signature dAltemaiqtacitly(or Generator). <br /> ig.Hazardous Web Report Management Method Codes fle.,codes for hazardous waste trogin"disposal,and recy&g systems) <br /> 4. <br /> -Ao <br /> 20.Designated Faft Owner or Operator Qffatim of h-iflit of"#US-m8loliall covered by to mean ax wept as.noted in Item 18a <br /> Nam M0 Day, Year <br /> Prin a <br /> 17 L5 <br /> _/VL A TY <br /> 22 -05)y Previous odrdons are obsolete�, fIGNATEDWILI T0.GENERAT0R,STATE(IF 9E06kED) <br /> 4E <br /> 1)1494 1/150135 <br />