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SSL SK SHIP# 227725670 111111111IIl�lliillilllllhNllill 0069596073 K5 Form Approved,OMB No.2050-0039 Please print or type. Z Pae 1 of 3.Emergency Res ease Phone 4.Manifest Tracking Number SKS UNIFORM HAZARDOUS 1.Gene atorlD Number TXR00008120 g 1 1-tl0tD-4�8-1760 0 0 6 9 5 9 6 0 7 V 1�V WASTE MANIFEST 5.Generators Nave and Mailing Address Generator's Site Address(if different than mailing address) SAFETY—KLEEN SYSTEMS, INC. AFET50 SAKLEENLIDA BSYSTEMS, INC. GO HOA 555 CA 95368 LVD SALIDA Generator's Phone: �209_54.x_1011 SALIDA CA 95368 _ 6.Trans oder 1 Com any Name U.S.EPA lD Number 5fFETY-{LEEN SYSTEMS INC TXROZOO81205 7.Transponer2 Comoany Name U.S.EPA ID Number CLEAN HARBORS ENVIRONMENTAL SVC INC. MADV139322250 B.Desi9nated Facility Nameand Site Address SAFFTY—KLEEN SYSTEMS, INC. U.S.EPA ID Number 6000 88TH STREET SACRAMENTO , CA 95828 316-386--4'313 CA0000m84517 Facility's Phone: 9a 9b.Us DOT Descriptor,(including Proper Shipping Name.,Hazard Class.ID Number, 10.Containers 11.Total 12,Unit 13.Waste Godes HM and Pack'irg Grcup(itany)) No. Type Quantity Wt!Vol. NON-RCRA HAZARDOUS WASTE, LIQUID ! DF G 134 o (AQUEOUS BRAKE CLEANER) z. NON—RCRA HAZARDOUS WASTE LIQUID DM 0 G 134 (AQUEOUS PARTS WASHER SOLUTION) 4. 14.Special Handling Instructions and Additional information TSD:SCA SAL CSG 24H EMERGENCY#800-468-1760-CH/SK/TFI-Contract retained IJy generator confers agency authori y 15. GENERATOR'SIOFFEROR'S CERTIFYCAIDON:t hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, marked and labeledlpiacarded,and are in at respects in proper condition for transport according to applicable international and national governmental regulations-If export shipment and I am the Primary Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. I cedity that the waste minimization statement identified In 40 CFR 262.27(a)(if I am a large quantity generator)or(b)ill am a small quantity generator)is true, Genemtcr's Offarors PrmtedfTyped Name Signature Month Day Year z04 A wz' Audi-i 19 CLL-il2 �C''1 16.International Shipments ❑Import to U.S. Export from U.S. Port of entrylexit. F— K Transporter signature(for exports only): Date leaving U.S.: W 17 Transperter Acknowledgment of Receiplof Materials F Transporter 1 PrintedlTyped Name 1 Signature Month Day Year z Transporter 2 Pomedlfyped Name Signature Month Day Year t- 18.Discrepancy 18a,Discrepancy 1ridcalion Space ❑ Quantity ❑Type ❑Residue ❑partial Rejection ❑Full Rejection Manifest Reference Number. >- 18b.Alternate Facility(or Generator) U.S.EPA ID Number J V LL Facility's Phone: 18c.Signature of Alternate Facility(or Generdor) with Day Year a Z 0 19.Hazardous Waste Report Management Method Codes(i.e..codes for hazardous waste treatment,disposal,and recycling systems) uJ 1 H141 z H141 3 -+ '-*_ 4 20.Designated Facility Owner or Operator:Cenifcation of receipt of hazardous materials covered by the manifest except as noted in Item 183 PrintedlTyped Name Signature Month Day Year EPA Form 8700-22(Rev.12-17)Previous editions are obsolete. DESIGNATED FACILITY TO EPA's e•MANIFEST SYSTEM 1)14626/156013 2)14941/156023