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SK SNIP# 2228634324 111111111 �I �IIIlil!!IIlI{Illlll! <br /> Please prim or MM. _ Form Approved.0M9 No.2050.0039 <br /> IL UNIFORM HAZARDOUS 1.Ger el ID hrmmoer 7 Pagell of 3. ma�t R a- PE 4.Manlfast Tracking Number �( <br /> WASTE MANIFEST TXR�@0$1205 � �•-tS6+t�—�i;�1� +a 006960207. ISS <br /> 5.Generatots Name s v tAaifirig MdrW <br /> Genera•ors Site Address;if different than maliq addrel <br /> SAFETY--KLEEN SYSTEMS, INC. SAFETY—KLEEN SYSTEMS, INC. <br /> PO BOX 555 50% SALIVA BLVD <br /> SALIDA CA 95368 <br /> pTmmnsporter <br /> nona-: SfLIIA r " <br /> CS 3SF9.TYSYSTEMS IC U3,EPA: mbTXROO9081 <br /> 205 <br /> CLEGatL ft.nnsNEPID NurbeN HARBORS ENVIRONMENT� SVC INC. MAI922c50 <br /> . <br /> Facility Name and s ce Address SAFETY—KLEEN 'SYSTEMS9 INC. us£PA 14 Ndml <br /> 6M 88Th STRMT <br /> 9if�386�-4 : 3 SACRAMENTO , CA 95828 <br /> Faritty's Phone: CABOQl0084S27 <br /> ga. 9b.U.S.DOT Desc ripimrr(rnduding paper SNppl Name,Hazard Glass,iD Number, 10Containers HM and Pal Group Rany); , Ii.T0181 12.Unit +3.Waste Codes <br /> NO. Type Ouentity MJVd: <br /> a <br /> P %9—ORAKEP F. DF <br /> 2. <br /> NON--RCRA HAZARDOUS WASTE LIQUID DM G 134 <br /> (AQUEOUS PARTS MASHER SMUT ON) <br /> 3 Lo <br /> IPIS M_ <br /> 4. <br /> id.Spe'zaitfandGripmshuctty.isanaAdd:tiatallnfo;maben <br /> TSD-.SCA <br /> SAL CSG: <br /> E4".EMERSENCY#SW--468-1768—CNISK/TFI-Contract retained by generator confers ene y authori y <br /> i5. <br /> GE <br /> NE#tA70R'SIt7FEERQR`SCERTIFICATION:I here>iydeclare that the cmntente e'dds consignment a,e fo y and am,,stely descried above ti tAa <br /> marketl and IabekdlplacaMed,eod are in al,ses in zmee W dil!on Ja tans Y per shlpp r+g name,and are classified,Packaged, <br /> Exporter,t rcrtity that ute stents of this coni men,oorsJcnm t pat acrxrdirtg m apphlc intemaapnal ano natona?geremme�tai regu a6ona:Ji export sMpmerd and t am the Primary <br /> Wal the terms o` w aftwec EPAA*1*wwgmentof Count <br /> I r;eruty utat ilre waste rn?gmiza6+n statecreo#;denoted lr riJ" R 2c2,27tai f,fi am a#arae quarWry gene, , tbt{dl am a smaP quanuiy generate' e. <br /> Nercrr'sP`intto#Jriy . Name. gnat,re <br /> ,/1I"1 Month Day Year <br /> ..mJernr�?r!alSh�men_ i�-� <br /> iJ tmportto U.S. Q Ekp!R Uom U.S. Pon of entvetdt . <br /> Transporter signa#tre(Jot expans only?: <br /> 17.Trans nerAckW Date leay>rig U.S,- <br /> ns. <br /> .ed�rrrento`R�ptofMaterJars <br /> ns. r 1PrirW 4rYPed Name . <br /> nature Mout Day Year <br /> As <br /> Month. Ray Year <br /> 18.Piac'apancy <br /> 189.Discrepancy lndke6an Space <br /> Quantity El,Tj e1—t <br /> ORestttue PartialReJaefion C]FwReje*n <br /> illb.Alternate Fac.ty(or Generaturf N!anffeSl ReJetenee tdurnbpi <br /> V <br /> U S.EPA iD Number <br /> fecaidy's Phone: <br /> 1tJdSignarin3MAX <br /> enataFec3,ty(orGeneretorj <br /> Malt` Day Year <br /> i9,Hazard^rs Wade Report Ma`agement Method ftles(;,?.,pries Jar drazarcor s v este treatment tks <br /> t a posai tri ra gating sys#ems1 <br /> 2 H141 3 a <br /> 2©.Ues'rgnatad FadlNy Qatser �t7,Rrator:�eNt�atior,of recaipi of nazarcMw maria#s corsred by the rr�niJsst <br /> Pantedr?yped.Name ry�/J J r,+/� exce{s'as rates fn Ptwn 18a <br /> MCI t3ay Year. <br /> EPA Form 8700.23 Rev.12-1Z) Pre s;ed tions are obsolete. <br /> 'j,•� +� 21.149411156523 3t*-it 34 DESIGNATED FAC)LI PA's e-MANIFEST SYS" M <br />