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SSL SK SHIP# 227170258 <br /> Please print or type. 0 0 6 6 8 7 7 6 4 S K S <br /> Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1,Generator ID Number TX ROOM1205 Z Pagel of 1 3.Em R�s�e � 4.Manifest Tracking Number <br /> WASTE MANIFEST 1 <br /> 1 1006687764 .SKS <br /> 5. n ek ilio Address Generator's Si Address f8 dirterent than mail in address) v v <br /> —KLE SYSTEMS, INC. TY—FCLEEN SYS7 MSS INC. <br /> PQ BOX 555 SALIDA BLVD <br /> SALIDA CA 95361 <br /> Generators Phone: 209-545-1011 SALIDA CA 95368 <br /> s.Tr rMf°—*Uft SYSTEMS INC U.S.EPA ID Number TX R00008 i205 <br /> 7.Transpoder2"MMS <br /> Name U.S.EPA ID Number <br /> CLEAN H�E�BORS ENVIRONMENTAL SVC INC, MAD039322250 <br /> B.Designated Facility Name and Site Address SAFETY—KLEEN SYSTEMS, INC. U.S.EPA ID Number <br /> 6000 BOTH STREET <br /> Fadkrys Phone: <br /> SACRAMENTO , CA 5828 <br /> 916-386-4913 CPAMOO84517 <br /> - <br /> ga, 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 0.Containers 11.Total 12.Unit <br /> HM and Packing Group(if any)) 13.Waste Codes <br /> LO-- Type Quantity Wt.Nol. <br /> 1. <br /> o ( n� <br /> a <br /> Z z NON—RCRA HAZARDOUS WASTE LIQUID DM G 134 <br /> LLI <br /> (RQUEOUS PARTS WASHER_SOLUTION) / <br /> 31 TrAun <br /> 4. (/ <br /> 14. peeial Handling lnstmctions and Additional Information TSD:SCA SAL CS+S.- <br /> I <br /> 24H EMERGENCY#800-468-1760—CH/SK/TFI—Contract retained by generator confers aggency authori y <br /> on initial transporter to add or substitute additional trans anter, on enera? is behalf. <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION:I hereby declare that the contents of this consignment a he <br /> fully and a rarely described above by the proper shipping name,and are ctassihed,packaged, <br /> marked and labeled/placarded,and are in all respects in proper condition for transport according to applicable intemabon land 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 EPAAcknowledgment of Coni <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if!am a large quantity generator)or(b)(d I m a small quantity generator)is true. <br /> Gsl0fferors Pn hyped Name - Signatu '� Month Day Year <br /> l I i <br /> 16.Inte tional hipments <br /> r ❑Import to U.S. ❑Expart from U.S. o f entry/exit <br /> ? Transporter signature(for exports only): leaving U.S.: <br /> CC 17.Tidnsporter Acknowledgment of Receptor Materials <br /> r Tra r1'P ed/typed arae tA^ SignaN Month Day Ye <br /> «� 3 j <br /> Z Transport Pnn da Vine Signature Month Day Yea <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space <br /> ❑quantity ❑Type ❑Resi jue E]Partial Rejection LJ Full Rejection <br /> Manifest I eference Number: <br /> 18b,Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> Facility's Phone= <br /> w I Be.Signature of Alternate Facility(or Generator) Month Day Year <br /> a <br /> z <br /> 19.Hazardous Waste Report Management Method Codes(i.e,codes for hazardous waste treatment,disposal,and recycling systems) <br /> p 1. 14+442. H141 3' U144W-1-- e,::-,-, 4. <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 1 Be <br /> PnntedlTyped e/ e — Signature Moth Day Y r <br /> fill <br /> v <br /> EP oA7Iec2P�'rgvoditior�sl6plTs�lQ�te. DESIGNATE ACI YTOEPA'se--MANIFEST SYSTEM <br />