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Fi H I P# LD F65945'R8 <br /> Please print or type. 0 0 6 7 7 7 B 3 1 S K S <br /> Form Approved.OMB No.2050.0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number t 2.Page of 3. me Res a p� 4.Manffest Trackin Number <br /> WASTE MANIFEST T,{.2000¢181. `' -1 <br /> 0067778315.Generators NSKS <br /> me and Mailing Address Generators Site Address(it different than mailing address) <br /> ,SAFETY--KLEEN SYST=.MSI INC, SAFETY--K!_E`N SYSTEMS. INC, <br /> PO BOX 5-15 5050 SAE-IDA Bi.-VD <br /> EPI TDP. CA 95368 <br /> Generators Phone 209-545-1011 SAE I DA <br /> 6.Tr�ggppltgrl.Cpm�py S INCmber I <br /> SYSTEM + . U.S.EPA ID <br /> HHFFttTTYY LL - TxR0,0ta,08;I c-1,fs <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> CLEAN HARBORS ENt IRONMENTAL SV-, INC. t R,+tT. ;,'=;_E=' l <br /> B.Designated Facility Name and Site Address SAFETY--K€-EEN SYSTEMS, TfVC. U.S.EPA ID Number <br /> 64 010 88TH STREET <br /> SACRAMENTO � CA 95828 <br /> 16-'PF•-4'�].-�, t�fl01�1�00t3r+r,7 <br /> Fadliry's Phone <br /> ga. 9b.U.S.DOT Desonpdon(including Proper Shipping Name,Hazard Class,ID Number, 0.Containers 11 <br /> HM and Packing Group litany)) o. Type Quantiry Wt.Nol.Total 12.Unit 13.Waste Codes <br /> I. <br /> O ! - �� n <br /> ff <br /> Lu <br /> w 2, NON-RCRA HAZAR'Il WASTE LIQUID DM $� p5 34 <br /> r <br /> (ADUEOUS PARTS WQSHFR SOLUTION) 1 <br /> 3' NON-RCRA HAZARI'€IUS WASTE LIDUID DF <br /> (AQUEOUS CARTS 1,P.9HFR SbLUTION) C 17,4 <br /> Q <br /> 4. <br /> 14.rpcial Handling Instructions and Additional information TSD SCA <br /> SAL CS6; <br /> 24H EMERGENCY#800-46a-1760-CHfSKfTFI--CDntrar-t ratained by generac <br /> tor anfe^�. ar�enry aatthnri y <br /> on initial ran rtnr tD d r } <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION:I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, <br /> marked and labeled/placarded,and are in all respects in proper condition for transport according 10 applicable d emadonaland national governmental regulations.If export shipment and am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)lift am a small quantity generator)is true. <br /> G torVOfferors Pnnted(Typad Name Signature Month Day Year <br /> wt J o a <br /> J16.lme tic I ShipmenE <br /> F- ❑Import to U.S. ❑Export from U.S. Pon entry/exit: <br /> Z Tran orter signature(for exports only): <br /> eaving U.S.: <br /> W 17.T nsporter Acknowledgment of Receipt of Materials ' <br /> Lu <br /> T der 1 PrintedlTypName Signature Month ay Y r <br /> G me /0 <br /> z Trans P ted/Typed Name Signature MvnthDay Year <br /> 18.Discrepancy <br /> 18a,Discrepancy Indication Space ❑quantity ❑ <br /> TYPe ❑Reside ❑Partial Rejection <br /> ❑Ful!Rejectlon <br /> Manifest Reference Numttec <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> if Facility's Phone: <br /> w 18c.Signature of Alternate Facility(or Generator) <br /> ¢ Month Day Year <br /> z <br /> 00 -19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling sy*ms <br /> LU o !'4 /1 2, H141 3' H 141 4. <br /> 20.Designated Facility Owner Dr Operator Certification of receipt of hazardous materials covered by the manifest except as nded 1 It 18a <br /> Prinfedlfyped Name Signature _ r M 0 / <br /> EPA Form 700-22 R v.12-1�Previous editions are obsolete. <br /> 6(tt# 2)14941/L56023 3)14941/1562123 DESIGNATEi1 FA I EPA's e-VANIFEST SYSTEM <br /> �'v <br />