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SK %IIP# 226693952 �I��I�I�Il�I�I�IIIIII�I�lll�l II I II1 <br /> 0067762365 KS <br /> Please print or type. Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS <br /> _r77r,_ ID Number TXR001211111131205 1 0 12-Page4of 3.9mefgency Response Phone 4.Manifestmber <br /> WASTE MANIFEST I00MWi6236 SKS <br /> S.G?'� °Fs��1e `ffATEIS, INC. Genera` rare ridtenjthanmailingaddressi <br /> � - r <br /> 5050 SALIDA bi_. <br /> _ CA 957,68 <br /> 2t�9-5�t i-11T 1> <br /> Generator's Phone: SAL I ISA <br /> 6 TramK,v t# o" 0 SYSTEMS INC U.S.EPA ID Number T X RL40006 <br /> 7 Tr llgf�Co <br /> tQn__�, fflW S ENVIRONMENTAL svC U.S.EPA Ip Number TNC. MAD03932C`:_ <br /> 8 Designated Facility Name and Site Address SAFETY—KLEEN SYSTEMS, INC. U.S.EPA ID Number <br /> =:000 88TH STREET <br /> SACRAMENTO , CA 95828 916-386--491 A0000084 3 t 7 <br /> Facility's Phone' <br /> ga 9b.U.S.DOT Description{including Proper Shipping Name.Hazard Class,ID Number, 10.Containers 11.Total 12.Unit <br /> 3.Waste Codes <br /> HM and Packing Group{if any)} No. Type Quantity Wt.lVol. <br /> Ir <br /> LU <br /> 2 : U D t. � 1 ) <br /> Lu � i r T'' 1ra'-_�i.I->~ ..f <br /> 3 <br /> 4. <br /> 14.Special Handling Instructions and Additional Information TSD;Sr'I, SAL n <br /> 2*H CMER>3ENCY#800-468--1.760—CH/SK/TFI—Contra,-t retairied by generator Confers apr;stenvy alithor <br /> n1 1r11t1a] tl"'ngnsp'1"t Pr }ci ziocl Or 511fh5tlt!Ite additinlia1 . <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby deGare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified.packaged, <br /> marked and labeledlplacarded,and are in all respects in proper condition for transport according to applicable international and national gevemmental regulat ons.If export shipril and I 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)(f I am a large quantity generator) I am a small quantity generator)is true. <br /> G ra r'slOfferors P edlTyped Name Signa a Month Day Year <br /> 4 011 1 Au I I <br /> 1 Is -> <br /> J 16.IntO <br /> ation Shipmenls <br /> Z ❑Import to U.S. ❑Export from US. rt of ertrylexit <br /> Transporter signature(for exports only): ate leaving US. <br /> W <br /> 17.Tr <br /> 4A&Wr1erAcknowledgmentofReceipt ofMatertaks <br /> T rpr 1 Pkntotl d Name Signat Month Day Yuac. <br /> rx. <br /> X TFans n ntedfType ame Signature Month Day Year <br /> 1 <br /> 16,Discrepancy <br /> 18a-Discrepancy Indication Space El <br /> Quantity Ll Type L1 Residue ❑Partial RejeCGon El Full RejeCBon <br /> Manifest Reference Number: <br /> 18b-Altemate Facility(or Generator) U.S.EPA ID Number <br /> J_ <br /> U <br /> rai Facility's Phone: <br /> w 18c Signature of Alternate Fagfity(or Generator) Month Day Year <br /> Z <br /> 55 19.Hazardous Waste Report Management Method Codes(Le,codes for hazardous waste treatment,disposal,and recycling systems) <br /> LU 1 2. <br /> 20.Designated Facility Owner or 9perator Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Printed'Typed Name ��� Signature � M th Day____Y_ea_rjr <br /> 3 <br /> -1-7 PPP PPP PrevtouS.editipnsare ATED FAC T A's e-MANIFEST SYSTEM <br />