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SSL SK SHIP# 2228107434 1111111111111111111111111111111111111 <br /> 0069544945 K5 <br /> Form Approved.OMB No.2050-0039 <br /> 'Please print or We 1 Generator ID Nrni 2.Page of 3. me R e P 4.Mani st Traekin Number <br /> UNIFORM HgZAR00US CAT000613968 - � � -t° 0 0 6 9 g44 <br /> 94 SKS <br /> WASTE MANIFEST <br /> 5.Generators Name and hlailir Address Generator's Site Address((f different ihan mailin address) <br /> SAFETY—KLEEt� SYSTEMS, INC. SAFETY—KLEEN 5YSTMS, INC. <br /> PD BDX 555 5M@ SALIDA BLVD <br /> SALIDA CA 95368 CA 95368 <br /> 209-545-1011 SALIDA <br /> Generators Phone. <br /> �ppc p� yI}u� u.s EPA iD Number TX 8000081205 <br /> 6.TrtSflhttVmtSCkC1`T SYSTEMS INC <br /> 7,Transporter 2 Compan Name U.S.EPA ID Number <br /> CLEAN HAFBURS ENVIRONMENTAL SVC INC. MAD039322250 <br /> 8.Designated Facility Name and site Address THERMO FLUIDS INC U.S.EPA ID Number <br /> 12533 SE CARPENTER DR <br /> 503-788-4616 CLACKAMAS , OR 97015-8968 OR0000025197 <br /> Facility's Phone: <br /> ga 9b.U.S.DOT Description(lne udirg Proper Shipping Name,Hazard Class,ID Number, 10,Containers 11.Told 12.Unit 13.Waste Codes <br /> siAR and Packing Group(if ani No. Type Ouantity Wt,NoI. <br /> NON—RCRA HAZARDOUS WASTE SOLID DM P 223 <br /> o (DRAINED/UNDRAINED USED hIL FILTERS) <br /> LU 2 <br /> w <br /> 4. <br /> 'vl Special Handling instructions and Addi'.ioral Information TSD:TPP SAL CSI <br /> 24H EMERGENCY#800-468-1760—CH/SK/TFI—Cantract retained by generator confers aggency authori <br /> on initial transporter to add or substitute additional trans orters on enerataIll behalf. <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,aria are classified,packaged, <br /> marked and Iabeledlplacarded..and are in all respects in proper condition for transport according to appiicaNe international and national govemmentaE regulations.if export shipment and I am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. <br /> I certify that the waste minimization_ctatemen€idendtted R 26227(a)(if I am a large quantity generator or(b)fif l am a s ' enerator)is <br /> fferdrs Print, am e _ gnature Month Day Year <br /> 0 <br /> 7rMernallonai ShipmentsF-I Import to U.S. ❑Expod from U.S. Port of entry!exit: _ <br /> ? Transporter signature(for exports only?: Date ieav rig U.S.: <br /> W LLI17.TransporterAcknowledomentof Receipt of Materiala <br /> nsp er 1 Printetlffyp a nature Month ..Daayy� Year <br /> o �, � f <br /> Z i sporter 2 Printed ' ame a.ure <br /> Month Day Yea <br /> F <br /> 18.Discrepancy <br /> Discrepancy Indication Space Quani ❑Type ❑Residue D Partial Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> ,}_— 18b_Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> UuE <br /> ct, <br /> a <br /> Facflicys Phone. Month Day Year <br /> LU <br /> 182.Signature of Alternate Facility(or Generator) <br /> M <br /> a <br /> z <br /> m19.Hazardous Waste Report Management Method Codes(i e...codes for hazardous waste treatment,disposal,and recycling systems) <br /> 4. <br /> 20.Designated Facility Owner or Operator Certification of receipt of hazardous materials covered by the manifest except as noted in It las <br /> PrintedlTyped Name Signature Month Day Year <br /> EPq Fomt 8700- Rev,12-17 Previous editions are obsolete. DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM <br /> 1178726��/1561 <br />