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SK SHIP# 224446868 0 0 6 3 2 5 7 4 4 S K S Please arint or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Paye 1 of 3.Emer ency Response Phone 4.Manifest Tracking Number WASTE MANIFEST T X 800008120 i 1 1.�8 �'46B—1 76 1006325744SKS 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) iAFETY--KLEEN SYSTEMS, INC, f;iY' `.i r %: .'._ <. ,Lj`ja; TNC. PO BOX 555 5050 SALIDA BLVD `-SALIDA (CA 95358 Generator's Phone: 209-545-1011 SALIDA CA 95368 6. t�CgmpagKneSYSTEMS INC U.S.EPA ID Number rX R 0008120�i 7.Transporter 2 Company Name U.S.EPA ID Number CLEAN HARBORS ENVIRONMENTAL SVC INC. MAD039322250 8.Designated Facility Name and Site Address SAFETY—KLEEN SYSTEMS, i NCa U.S.EPA ID Number 60010 88TH STREET SAfWRAMEi'JTD , CA 95829 916-385-4913 CAt000t008451? Facility's Phone: ga. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit HM and Packing Group(if any)) 13.Waste Codes No. Type Quantity Wt.Nol. • _.. "f W U.1 2 NON KORA HAZARDOUS WASTE, LIQUID �Q CD (AQUEOUS PARTS WASHER SOLUTION) _ 4. 14.Special Handling Instructions and Additional Information TSD 2 SCA 9PI_ 2''t HR EMERGENCY #1—•800-458-1760 (SK / TFI) v L4 2� AlITH nc u 5F- g'1'_..Fn9" BY r:FN TO RFTATN ` f CN5,,F,"1 r 3 1? s :,;• r -.f_ � 15. GENERATOR'S/OFFEROR'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, marked and labeled/placarded,and are in all 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 EPA Acknowledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a small quantity generator)is true. Genera Offeror'sPrinted TypedName Signature Month Day Year j l�� ! !0 J 16.International Shipments Z Import to U.S. El Export from U.S. Port of entry/exit: Transporter signature(for exports only): Date leaving U.S.: L= 17.Transporter Acknowledgment of Receipt of Materials OTransporterlPrinted/Typed Name Signature�-��Z - '�► r� Month Day Year Z Tra n§pl5rtErr rime Name Signature Month Day Year H 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity El Type ❑Residue ❑Partial Rejection ❑Full Rejection y Manifest Reference Number: ~ 18b.Alternate Facility(or Generator) U.S.EPA ID Number J U Q Facility's Phone: UJ 18c.Signature of Altemate Facility(or Generator) Month Day Year Q Z y19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) w 1 2. 3. — 4. 20.Designated Facility Owner or Operator Certification of receipt of hazardous materials covered by the manifest except as note in Item 18a Printed/Typed Name I Signaturer Month Day Year (/ �/ 1 1114 Z I / I M EPA Form 8700-22(R&3-05) Previous editions are obsolete. DESIGNATED FACILITY TO S ATION STATE(IFR GIUIRED)