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FIS tiK SKIP# 225955040 f <br /> Please pnnt or type.(Form designed for use on elite 112-pitch)typewriter.) Form Approved.US No.2056-0039 <br /> UNIFORM HAZARDOUS Ge.�era'prlD Numlr T,�R� � �1 >�` 2.Pagel)ofWa ,lst Tracking Number <br /> WASTE MANIFEST aQn118J7Q 7 <br /> FLE <br /> 5 Generators Name and ASading Addrn S Genera&S SP,e kdress lirdidarent than Quailing adonis) <br /> SAFETY-HLEEN SYSTEMS, INC. SAFETY-KLEEN SYSTEMS, 1W. <br /> GI) BOX 355 SOSO SALFDA BLUD <br /> SAL T T)A CA 95358 <br /> Genera;afs Phone: <br /> 2-09-545-1011 I SALIDA CA 95368 <br /> 6- "dr. nrCrl . -Ef'; Iti1S,EPA ID Numh1RfQ��$j�QSs -X <br /> _ <br /> 7.Transporter 2 Ccmpany Nante U.S.EPA ID N;mlber <br /> 8,Desnnatad Fa'y%ame and See Adem:s C-PFETY—KLEEN W CALIFORNIA u,s,EPA ID Ndmher <br /> 6990 SMITH AVF. <br /> NEWARK CA '44560+ <br /> 51171-799-4400 CAD980987418 <br /> Fac'i lvs Ph„e, <br /> g3- 4d.U S,DOT Dasmoon lnchi6ng Proper Shipping Name.Hazard Class.ID Number, ID Ccnainam 11,Toml f2.Unit 13 Waste Codes <br /> H-t and Farkng Croup(dany)) No. Type Quantal V'VVgI. <br /> i. NON-PCRA HAZARDOUS WASTF, LTDFIID TT G ?? <br /> 0 WSEP OIL? <br /> W <br /> i <br /> Jr- <br /> 4. <br /> i_ <br /> i <br /> 14.SparralHand''ingnstyuV­.m;and Rtldaionalink mnabon T_r) FV€: SAL CSG-: <br /> EMEPGFNCY#8171@-468-1760-CHIGK/TFI--Contract retained by generator confers aggency arithori y <br /> - initial transporter to eda or substitute additional transporters on nenerNor's behalf. <br /> 15.1 GENERATOR'WOFFEROR'S CERTIFICATION:t hereby declare Ihat the earitenls orthts consignment are fully and accuratelyces9lbedabon by rht proper,shipplrg name.;Nana classtrted,paGmged, <br /> marked and labeled,'pincarded,and are in atl respecks In propercondfw for Transport a=rdir.Qtd apffl'rab!e mlema;tcnal and na?iunal ga+emmenW reg0alWS Ife>poo Shil)Mrland I am the Primary <br /> Enorter.I cerin;lhal are wn;enls of Ras rpnsignmem Cpnforrn to Ire)arms ofitis atiached EPAA r.1_Iedgmenl of Con at <br /> I ceddy Nal Ino ,asle nommlo:Vicn sl+lomant idpsfRPd in Ap CFR 262.27IaI(If I em a large G'.:arlty garreralor)dr Ib)Hr1 m a s'1 Il GunnSy genaratr)Is we. <br /> enerarnrst rots Frrmedr ypea Niue g�na ure ru ay car <br /> L,f -7116 Ee <br /> _i1'p.Inlemamnalshipments I- <br /> F ❑ImpoR W 11.5, ❑Emoxl from US. Pan W enty'oxif _ <br /> Tran000ner sl alum(far eracns only): J Oz;e I vin U.S.. <br /> W 1-r.Trsnapc.".erAc4n7r'�gmcrri o!keapt o!F,latnna!s <br /> Transpoe, 1.1,nith Day Year <br /> Q ( 07 1L r& <br /> CL <br /> Z Transpoder 2 PrinteGTyped Nama Stgnalti� M,V; way Rear <br /> 4 <br /> rY <br /> H <br /> 1 tE P''sc+epanry <br /> I 186.D SCrepanCy Ind:rapon Spate ❑Quantiy, T ❑ ❑Pamal Full Re;pctign <br /> r4 rVeal Re!arenrs Numhar <br /> I5b.A!emx:2 Fara ity ldr arxiali: US.EPAID Number <br /> J_ <br /> L) <br /> Q <br /> LL PaGal''S PbCr:e' <br /> w 18c.Sig:cure of A7.arnata Fpm',!y far Generator) Month Dav Year <br /> r <br /> a <br /> z <br /> 14.Hazardous Wave Report V.a agemen!Alefhdd Codes il,e,codas for hazardous waste Ima'.menS.c1syosa1.end mcycfing systems) <br /> 1 �� I Z 3. 4. <br /> 20.Desigaaled Fas i,y C:.nar w%ara;or.Cerhfcabpn of raceictcf hazardous malrrrnls=,eyed by the marllesl except as need in Item 18a <br /> Printedayped Name „cam /k _. Sgnalure hlcn:r Day Year <br /> EPAFa m 9740 7[f n 3-5�PfevsedGonsarerealbbsoolllelel��� <br /> ouSIG. 0 FACILITY TO DESTINATION STATE(IF 9EOUIREGi <br /> tY7,1�4•,r � C� <br />