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SSL SK SHIP* 229457850 1111I11111111N1i11 <br /> 009159196SK$ <br /> Form Approved.OMB No.20540039 <br /> Please pnint a type. — 4.ft -MCK n nm6er <br /> IINIFORY HA7ARp0U3 1.0croa(ar ID NteMer CAT 13%8 2 Pa 1 of 1(btl D 0 1 �' S It S <br /> WASTE WHIFFSi <br /> S.C�xremrs Hm+e and Mai Addrem [ew;rlara S&AMd d dftanr3 than address,INC. <br /> SAFETY--4t1�E1 SYSTEMS, INC. SPFETY SYS MS, <br /> PO BOX 555LIDA 5059 SALIDA BLVD <br /> SALIDA M-545-10115-1911 GA 955368 SACA 95348 <br /> C,nraalces Phb w u.a l:PA lO Number T X R090'081295 <br /> 6TjffPrjf—j&r'M SYSTEMS INC <br /> T Transporter 2 Marra uS EPAro Number <br /> CLEAN k{AI�BOR'5 EP4V SVC INC. MgD939322258 <br /> 8.DeSigrNted Fariliry Nana and SitsAddross <br /> T}ER111[3 FLUIDS INC Us.EPAroNumber <br /> inn 9E CARPENTER DR CLACKAMAS DR 97015-898A <br /> 583-788-4615 OR[AdOW5197 <br /> faclays Pgorc. <br /> ab.U S.DOT Deaacuun(MOW"Pmw shipping Name,kaza d 0m.(C Nambw. 10.ccrty ra 11.Tow 12.(Alit 13 WWI&h§Codes <br /> Mand PacwqGwp Pl am7)) No. T1va D,mrtty VRl4ti. <br /> NOpI—ACRA HAZARDULtS irIRSTE SOLIA 119 $UCS P 223 <br /> p fDRAIFEDfUNDRAINED USED h1L FiLTER$1 <br /> o� <br /> z z. <br /> W <br /> i7 <br /> 3. <br /> <. <br /> 14.Spsw Herding vwfuctom ant AZ*onal t*ffru do TSD:TPO SAL CSG. <br /> - <br /> e <br /> EMR6ENCYMa00-448-17WCH/SKITFI-Contract retained by generator confers agency authori y <br /> nn initial transporter to add or substitute additional transporters on enera or's behalf. <br /> I ale aril nlesuEetl ebb a by the prcfpar Pph9 rams.and are dwABd.a1A]ed_ <br /> 17 Cf NERATDR'$rCFEEfl4R'S CEftiIP1CATI0N: hereby Oatlere lire,me mrt�nts or C'E mrergrnnen fury aaruramy <br /> marked and hbeledoa coed,and are L,all ffizP"in PMPer radHw ior,araport aoeordn9 t apdin.N8 r ill-fi nakad'-bond yo�emmerda'ragnlabare-d export shlprerl and I am n,e Primary <br /> ExboRrt,:oabtY drat aye mraerca of Des crosigmra�t cvManrl b tee of CIe ai�G+ed EPAAdarolakaBmertot Cotreara <br /> I ratitr that the waste mainufton ,l- n m CFR 26227(a)fat am a WP quan;ry MUM)d(b)Ill i am a s+nelV aienity grrleralar}is bue hivM 0M yes <br /> ZWOISI��� <br /> [ R <br /> Mufflado ❑vnw U.S. ❑Ezpdt hom U.S. bels � .;— <br /> Tro4parler sgnsat,"llor agrr�oraYY <br /> 17.Trar>9PorrPlFdaldaaetl4r1911t o1 f7naeipt d Ma16 Month pay Year <br /> I PrirdMlYYped <br /> r Et4tl+ pay Year <br /> p <br /> td. <br /> nm­ <br /> lea oscrww)wcawn awe G('>•a h TY9e ❑Resdae ❑Pew R,.:,. ❑Full ReterSan <br /> uuna g wanerrR Number. <br /> U S FPA ID Bomber <br /> IEo-Aaamate Fadity�a r�era6xl <br /> bad <br /> U <br /> adi Fecaara[l ane' Mort Day YW <br /> 184 moiAYmate Faifry(a Grr�aatnrl <br /> 4 <br /> 19.Harardous Wavle Repot frfer'genamtl McNod Cdtlea Cl.e_ooW for hazarams eruele tieahmeM,dapnxal.and rxyrWp syalerrrl 4 <br /> 2. <br /> 20.]acgnaled Fa31r Oerer rx Cp"m C 4kabon af r®Iptof humidors r eterlar5 mveeed by fibr anM1eet aarept es ndetl!Ohm lila <br /> Day Yar <br /> t . vw i+, <br /> Na" <br /> EPAFtmn 8704.22`R -17 Prerloaa e6reane a�olete. ESIGNATEE)FACILITY TO EPA's 9-MANIFEST SYSTEM <br /> 117972676/ <br />