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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 />