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7-195-0I <br />Please prtntor type. (Form designed for use on elite (12 -pitch) typewriter.) <br />1 <br />Form Aoon ved OMB No 2050.0039 <br />EP Form 8700 22 (Rev. 3-05) Previous editions are obsolete. <br />1,)lsu3ASfi3 l) 3i �) <br />1)2425440/40314352 <br />DESIGNATED FACILITY TO GENERATOR <br />UNIFQRM HAZARDOUS1 <br />MANIFEST <br />�"ef" ID Number CADOO 47 716 0 6 <br />2. Page 11 <br />3. Em s <br />7 <br />4. Manifest Tracking Number <br />17 , ? 4 SKS <br />WASTE <br />1 <br />U- ': <br />! } <br />5 r <br />5. Generators Name and Magi Address Gen S (if different than ss) <br />CALIFORNIA T�NK LIMES INC 2 <br />PO 30X 6245 3105 S tL DORADO ST 0 2009 <br />MCKTON CA 952106 0215 <br />209-466-3554 B y <br />Generators Plane: <br />h �` i KLGGI4 SYSTEMS, INC. S AID Number <br />U.TXRO00050930 <br />7 Transporter 2 Compan Name U.S. EPA ID Number <br />r , A 01<0 78/-S997,91 <br />8 Designated Faakty Name and Site Address SAFETY - K L E E N SYSTEMS, INC . 'S. EPA ID Number <br />amu". )'! 7 Z Z C 0v C EE R b <br />R Bbi r . 6CAMO .1, t 767 01 0A 936514 <br />FactitysPhone: `%— 100 1 7'< 0-77403371 <br />9a. <br />9b U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, <br />10. Containers <br />it 'cWi <br />12. Urn <br />13. Waste Codes <br />No. <br />Type <br />HM <br />and Packing Group (if any)) <br />Quantity <br />IMJVol. <br />YI <br />RQ WASTE FLAMMABLE LIQUIDS, N.O.S. <br />DM <br />G <br />DOO <br />211 <br />o <br />(P-CHLOROSENZOTRIFLUORIDE) <br />— <br />3 UN1993 PG III (DO01) <br />w <br />Z <br />w <br />ria <br />3 <br />s <br />I <br />14. Speciad Handkng Inslnxtions and Additional lnbnndw SK 'T C K 4110 46 0719 0000 371121 <br />1)ERGE128 4 s, <br />SK AUTHORIZED TO RETAIN LICENSED SUBSEQUENT CARRIERS AS NECESSARY <br />15 GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby dedsre thal the contents of this consignment are fully and accurately described above by the proper shipping name, and are ciassdied, pacMaged, <br />marked and abetedlPacarded, and are in all respects in proper condition for transport according w appkcable mtemabonal and rational governmental regulations. 0 export shipment and I am the Prmary <br />Exporter, I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent <br />' certity that the waste mmmtization statement identified in 40 CFR 262.27(a) (d I am a large quantity generator) or (b) (it I am a small quantity generator) is true <br />GeneraWrslOffemrs PraitedlTyped Name Signature +Wren 0-1y <br />� <br />yy Lk <br />18- International Shipments❑ lthport to U.S. ❑ Export from U.S. Pat of entrylexit -- <br />Z <br />Transporter signature (fa exports ordy): Date leaving U S.: <br />tY <br />17. Tr of Receipt of Maottr(ele <br />� <br />Trans r t Print edlT Name '9!4 Month Day Yew <br />CL <br />y ` <br />ZCL <br />Tr er 2 Pan/tedrrMa DYear <br />J yped / M ay <br />' e <br />r! L Z �,� IY 17 <br />78. Discrepancy <br />18a. Discrepancy Indication Space Quantity Type ❑ Resnlue ❑ Partial Rejection ❑ Full R,,,,. <br />Manifest Reference Number <br />18b Alternate Faolity (or Generator) J S EPA iD Numbw <br />J <br />U <br />u- <br />I <br />Fadlrty's Phone' <br />W <br />18c. Signature of Altemate Facilry (a Generator) <br />MonBt Day Year <br />h <br />Z <br />Z <br />rn <br />N <br />19 Hazardous Waste Report Management Method Codes (i e., codes for hazardous waste Ueatment Aisp)sal. and recycling systems) <br />W <br />O <br />1 � � � <br />to <br />+k_�l 4, { <br />3. <br />4 <br />776 Factity Owner or Operator Cemlication of receipt of hazardous materials covered by the manifest kept nded in !tem Iiia , <br />P sped Name / gn re <br />f- Month 0,1y Y -Ar <br />EP Form 8700 22 (Rev. 3-05) Previous editions are obsolete. <br />1,)lsu3ASfi3 l) 3i �) <br />1)2425440/40314352 <br />DESIGNATED FACILITY TO GENERATOR <br />