HANtrtit. A CS4 24 David Buxton 06/01 /IS 11 : 15 PA4l 1
<br /> Safety - Kleen Systems , Inc . 3.
<br /> Approved, OMB No, 2050-0039
<br /> 2600 N Central E ,tpy , Suite zoo 3. EmergenCyResponse Phone 4. Manifest Tracking Number
<br /> Richardson , Tx 75080ft
<br /> CORPORATE : 800 -669 -5740
<br /> 24 HR BIERGEN(Y : son US 1 /4o (tiafety klren) Generator's Site Address (if different than mailing address)
<br /> 2095451011
<br /> REFERENCE NOR ,
<br /> Ub 10MLH6 SA27226 Salvation Aru!) 67085549
<br /> 1247 S Wilson Way SItvc WtEk : 2015 - 22
<br /> Stockton CA 'J'.> 10 - nAtt : u_ b/01 ! va 11 : 25
<br /> PHONE 21r
<br /> ILL '10 CUSIOMtHS HILL to AuDHtSS U.S. EPAID Number
<br /> A27226 Salvation Army
<br /> 1247 S Wilson Way
<br /> Stockton CA 95205 - 7036 U.S. EPA ID Number
<br /> PHONE 209 - 466 - is ' !
<br /> URCHASE ORDER# TAX EXEMPTII
<br /> PRODUCT /SERVICES U.S. EPAID Number
<br /> SERVICE/ TOTAL a
<br /> PRODUCT QTY UNIT PRICE TAX CHARGE
<br /> $6 'J UNUr: , } � Gl H1. . . 1 . 000 'J9 . USUU 8 . 17 102 . 5y
<br /> SERVICE TERM e4 WttK -
<br /> ;1027/ 10. containers 11 . Total 12. Unit 13. Waste Codes
<br /> +5000 IBI 1101 son tutt 'I ;<:: 205 . 0000 0600 205 . 00
<br /> SERVICE TERM 24 WEEK No. Type Quantity Wt.Nol,
<br /> 1 . . .. . _ .. ... . . . . _ .
<br /> Wt stili ,. . ,stat , v
<br /> CMT> : 1404 ?6tl3ZR4? qTV : 2n ; daT u •PP.UF)I 991UZ7 SKDOT 7512696
<br /> )0001 ttt , tits- SUHCHAR61: t 000 12 , 1500 1 . 09 13 . 24 - -`-'
<br /> IOIAL StHVIC't/PHODUCIS 511 . [ 3UU 9 . 56 320 . 79
<br /> TOTAL CHARGE 320 , 79
<br /> CREDITS 0 . 00
<br /> TOTAL DUE 320 , 79
<br /> UNPAID SALANtt Inito 1t 32o , 79
<br /> NERATUR STATUS
<br /> 220 lbs/month '
<br /> • Nt ,utirr• lrl' I ; r ;r . Ilial ( ;) site ahu ;, .- ...,.. «.r .,:altos ;al . At .• pruprrly
<br /> asslrled . pdtkdytd . IIIdt'ked and Sdbl1 . : , . dt "% t: In PI• Uper LUrldlLtUn
<br /> trdlsbpUrtdt ; ulr dLUrrl) ing to l " . ,_ jnlatium, or Ute
<br /> r.. rinevul ser Tran.purla1 ; ns-, .u,1I , ... . lhangr lint urrurrra
<br /> tlt» r ; rt Thr • tows»t let* ; 0 it . •• r t . .. : 1 nr• ; r, Ue«
<br /> :tsar «
<br /> u« 1A1 i.tu Its" w . Or /null Al t :t, : .,o .. . _ , ApA Thr "tonus
<br /> , 1•utat .-.rnl Iv I•r l:stmt( by 04« ' + -• (1) . rt rrrrll: in are fully and accurately described above by the proper shipping name, and are classified, packaged,
<br /> s'
<br /> the Gelrl' 1•dl TCI'IIJ and Cu,,d ; L ; 46q , r _ pdrdLely to Customer ;cable International and national governmental regulations. If export shipment and I am the Primary
<br /> (b) any SK dureement signed by Ct t i i t itself SK , and (2) vledgment of Consent.
<br /> . .. e.V.. a« 1 . ,1 t,- r•r i.. by ..« frrr.,. .. 1t., 1 _ . . Ina : . 11040 _
<br /> .I ,.oeftl shelved sett iun , SK ; s du llor ; L �d tv L."Idrye CUstuturr ' sn aerator) or (b) (if lamasmall quantity generator) istrue.
<br /> . ..,,,, 1 root, 111 IN trAsu , I :alto rr, . l ,t:tu. ,• te .• s : r ; .. . stoats tits irlait• i.lt.al )nature Month Day Year
<br /> un inU th : . frrvirr IN .del . awllu:r ; arts- lis . iutt Ana
<br /> „,I r, t .nr,r +. Tile r 11 y j.r•..o ;� a 0
<br /> ON 041111 : , »Ills Ott Swrrly -Kir r '
<br /> 111 . llv"uvt atilt p" ;nl gill, tivAuly L . r. I Cu. l ,uner AurvrNs 111" 1 it
<br /> 11 nut intrr:l:tcc any sUbstantt int- .L solvcat ur ars::^ou: cicaain� U.S. Port ofentrylexit:
<br /> list inn , 611144111419 withnst I ;Uuw
<br /> 11IAI1 , "ny IOaiAr•tluu. atatr Alla
<br /> «; r•.I1A„ ». I « t nn. l : l time , » a tolls t at I t._ . . I As$ 1 _". It ir, l ,., ,,l,.. t :..a0%, Date leaving U.S.:
<br /> "ells- at It. Lhr rural„al At.. 1r Ihr ,,At h ;tie rn. l ,we., r...• t torr ”
<br /> wl ; / ... its- ,.. I tlr ,, 11arl . int Un ,,. IIs» I tow rh»»r asset 0413 tlt `
<br /> ,
<br /> Lit Ur• otherwltte ; ntruduLe polycthlorirrdted bipheftyls (PCa • s) , )nature Month Day Year
<br /> rb ; e ; des , pest it.Wea , it ;11R inn, ur t inted hdcar• luul. Pld� te into the
<br /> 7Ve11L w• dyueuus Llemr ;ng UUIULiun . Safety - KI .en has Um LdpdLity '
<br /> 1 i . {lar+nirsrd tti . rpt • . l ,t ,.r "ntvn.• tarts " ir„ tit« .;,ant {,art '
<br /> abet sultent ; pa ; nl` Lhinnera , sulveuts dnd Pdinty yener•dted by gnature Month Day Year
<br /> Gomer : yr •Try t1rArl ; ny rillrr tdrtr ; rlgre , po:eder , erns st ill
<br /> . ; dUeT orulpt » ; e ;trg ltrrt Motors- ltylanr , lent rnl ..rmi nw,Ittivt , or
<br /> A, elm , I a, it .. than.. dr rt « n 'Audi eall e.«11tas. Clso. I &jasoev air . 111. 1 a
<br /> rr. 11.rr '1!lr tier r•ly, t1A . ; ry ;ag : I . t,�a., ty . t _ . . + rls>r11 flit
<br /> .. w., e.
<br /> Nnnhsendrdnn. u t . it, j tai,, w , r h sitel r .,4• i � r tar 4n l l ❑ Residue ❑ Partial Rejection ❑ Full Rejection
<br /> ylt "nit "p;tl ;1 � ills ,. tars law, r Itiinrr � p , signs is w ;tl r:1. r 1 1
<br /> trndrrre any nnn - rsenfilminn snhstanry into the SK Prnperty ,
<br /> : 1 •^lir. t .. ! li:r. ; trli•t •t y o Ira. s .. . I I. rr
<br /> . r ] Input ,. Manifest Reference Number.
<br /> ( pus- yr hl , atral b yd r ,yl . ( I :Il herh It late
<br /> t. I : t 111_ ,1 . .. , tell 1 Its 1.a . _ at. r •••-ata • _ . . '. I I . the . I «nr U.S. EPA ID Number
<br /> Est i ,rl rn.t... I : e ; • ; nt ; drrllwt too :err•• t .r• or III" SK Pr1pe •• ty
<br /> the event SIT [feeInLruJULLsurt ur suLh nun - Lunrurnrirrg hdemdurs
<br /> tote , Cmtunter duree> that ; t. P. ; 11 be re >ptine ;'ile rur dll cull . Asset
<br /> teases toots ; AltovelA ' rlt se tor. t ,
<br /> 1 ltispusdl «or« the'uun - r.onrurur ;ug wd te , r ;nOudiug Lhe• Lust ur+ - Month Day Year
<br /> : ;ptrent JcLuretmu ; ndt ; urs dltd etwLmctj:;rr: ! diw.Fu�dl . F ;Iral ; uvu ;L ;ag
<br /> Il be I•dst_d Lift the trttUal sereILL Ailed , 101 ;0l maty ; ntlude
<br /> :•real t6rr•gr: fve err : ; r ; ,. t ;r:• r a . t . .: ! . t. _ ..1_, . F ; :: a1
<br /> • r wenlAtIffsl m» It« 1 i. . Ihr tot 1 ; - t "it also 11400 IL44 In I wa alt and recycling systems)
<br /> r ; let Tr et: y slaaqtAl star I oqosi r , r n. "is least an . r
<br /> or ttrlyd 40as
<br /> tpUte , breach , derdnit ur mrar• epr eoen sal ; uu , the Cuvtumer d150 -
<br /> ^rrs that tilt pt•evn ;l ;ng party r: ;17 br rntitlrtl to retuvrr
<br /> rsurrdbla dtty'
<br /> urnc ' D fee" dnd Lush dssuL ;dted P: iLll the
<br /> still r.•r„ t . 4Arrl - Klrrn •. rAil :4rr to ,: r-_ .. stexceptasndediniteml8a
<br /> ac:ce. material ^ r take ret>:ir. a �a:,^. ? a , �n nc :ray ::cr._ti ! e ! :: . y .. tatUre Month
<br /> Day Year
<br /> ; tat :• or`ru: L^•- ^ ' n obt ; 0 - 1 ; •fn ! to {rrt•jrrvly tldtziry ; tn umter ' -•t -
<br /> rety - Kleer, reliea un Cuatus:er • s teprClelltaLlua. anti CUbtu{ttel'
<br /> Asa
<br /> .puu :oiblr rut L, runu ; ny Sdrety - KTeeu ur duty pruteaa tltatiyes Ll:dt ,$try
<br /> tet• Ihr 6I'A1-a , I « ; . r : t . as Ihr n,at eo. tale Lent. LlrJ TW TNF FVFNT nF
<br /> FMFRf.fNEl t. Al � ') 4 -t1H NnMAIrl" ;' I -ROU -468-11760 (va frty - Kleen) GENERATOR 'S
<br /> INITIAL COPY
<br />
|