Laserfiche WebLink
SK SHIP# 231853277 F•ems.. <br /> Please print or type. Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number FPaga l of 3.Emer enyc Res onse Phone F4—Manifest Tracking Number SKS WASTE MANIFEST CPR0ON55301 pt t—•g4�110--468• hone 0 t�7 313 5 9 S Ka7 <br /> 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) <br /> Tracy Hbnda <br /> 3450 Auto Plaza Pkwy <br /> TRACI Y CA 95376-0000 <br /> Generator's Phone: 9—�32-1400 <br /> 6.Transporter 1 Comany Name U.S.EPA ID Number <br /> SAFETY— LEEN SYSTEMS INC TXR00l081205 <br /> 7,Transporter 2 Company Name U.S.EPA ID Number <br /> CLEAN HARBORS ENV "C INC. MAD03932225@ <br /> 8.Designated Facility Name and Site Address CLEAN' HARBORS FL DORADO, LLC U.S.EPA ID Number <br /> 309 AMERICAN CIRCLE <br /> 870-863-7173EL DORADO , AR 71730 <br /> Facility's Phone: ARDM9748192 <br /> ga• 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total <br /> HM and Packing Group(if any)) No. Type Quantity 12.12.Unit Unit 13.Waste Codes <br /> o x 1 RU UN1950 WASTE AEROSOLS, (EACH, NOT c DM Q� P D001 D@105 D006 <br /> 0 EREEDING L CAPACITY), 2. 1 (D001) <br /> a <br /> w D111107 DON 331 <br /> z 2. <br /> LU <br /> 0 <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional Information <br /> TSD:EL 83671$12 TR34107 <br /> CS6: <br /> 1)ER6#126- <br /> 24H EMERMNCY#BW-468-1760—CH/SK/TFI—Contract retained by penerator confers agency authori y <br /> ' j A ! A \ <br /> 15. GENERATOR'SIOFFEROR'S CER IFICATION: hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, <br /> 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 <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)(if I am a large quantity generator)or(b)(if I am a small quantity generator)is true. <br /> Generator's/Offeror's Printed/Typed Name Signature Month Day Year <br /> —1 16.International Shipments' <br /> 10 <br /> Z ❑Import to U'S. ❑Export from U.S. Port of entry/exit: <br /> Transporter signature(for exports only): Date leaving U.S.: <br /> w 17.Transporter Acknowledgment of Receipt of Materials <br /> 0 Transports 1 Print /Typed Name r Signature Month �Day Year <br /> za V t �L� <br /> Tr er nn ed/Typed Name Sign ure Month Day Year <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space <br /> ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> i <br /> 18b.Alternate Facility(or Generator) Manifest Referen Number: U.S.EPA ID Number <br /> J_ <br /> ULL Facility's Phone: <br /> F18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> a i <br /> z <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 1 <br /> O 4 2• 3, 4. <br /> 20.Designated FaciI6 Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Prin ype`Nam 0 Signature Month Day Year <br /> I./Td �3 <br /> EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. A SIGNATED FACILITY TOG NERATOR <br /> 1)8694712/18&j608 <br />