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µ Ifllllllllllllll�lllll�IIIIIIIIIII�II <br /> 00715942 $ SK8 <br /> Please print ortax. Form Approved.OMB No.205N039 <br /> UNIFORM MAZARIJOUS 1.Generet°(ID.Namber 2 Page 1 of 3., merg y se 1 4,Manifest Trackin Number <br /> gt: <br /> WASTE MANIFEST 00719428 SKS <br /> 5,Generator's Name and Mallinq Address Generator's Site Address(if diiferem than mailliirg,ddrass) <br /> �,ft{.'.' � C[=hT INC <br /> r1 .tr r r r =,v<7r r T syr <br /> - <br /> Generator's Phone: <br /> 6:Tri cwt or.Mn U:S.EPA ID Number <br /> 7.Transporter 2 Company Name V.S." EPA 10 Number <br /> 8.Designated Facility Name and Site Address SAFETY--KLEEN SY13T M9 U.S.EPA ID Number. <br /> r001?. A8TH STRFFT <br /> 5pi PAMENTO � <br /> Facili s Phone:. <br /> CA <br /> ga. 9b:U.S.DOT Description(including Proper Shipph q Name,Hazard Class,ID Number, 10:Conlsiners 11.Tote) 12.Unit <br /> HM and Pad ft Group(if any)) No. Type Qua►Nty Wt./Vol, 13.Waste Codes <br /> z 2. RON-.RCRA HAZARDOUS' WASTE' LIQUI£ DM <br /> (ARIEC1119, FARTS WASHER SlUTION) 1.00 <br /> 117%,,.r fr_ <br /> 4. <br /> 14.Special Handling instructions and Additional information TSD,51Y <br /> I?W FIfitERBENCY#800-468-1761 --CH/5K/TFI--Contrar_t retained by generator confers agency autho i <br /> an itzitial transporter to ,add lir suibstitute additional trans or er on rator's eh f <br /> 15. GENE.RATQR'SIOFFEROR'S CERTIFICATION:1 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 intemativialand national governmental regulations.9 export:shipment and i am the Primary <br /> Exporter,l certify that the contents of this consignment caufomn to the terms of the attached EPAAcknowledgment of Consent. <br /> i rxtrtify#hatttre waste minimization statement identified in 40 CFR 26227(a)(if 1 am large quantity ge or(b)('d i am a small auentItygenerator' e. <br /> !erors PrhnttTypor�Name gnature Month Day Year <br /> .n ematlonal Shlpments <br /> import to U:S, Export from U.S. Port of entrylexit: <br /> ? Transporter signature(for exports only): Date leaving U.S: <br /> W 17.TrenspotterAcknowledgment of Retxdpt of Materials <br /> s r 1 Nntedffyped Name gnatureMoynth tl)sy Year <br /> rter 2 RrWed/T ame ur Month Day Year <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space f��77 <br /> ❑Qtlahtity Q Type u Residue ❑PeNei Rejection' 0 Full Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Fadity(or Generator) U.S.EPAiD Number <br /> _J <br /> V <br /> Facilitys Phone: <br /> C2 18c Signature of Alternate Facility(or Generator) Month Day Year <br /> a <br /> z <br /> as19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatrnetrt,disposal,and recycling systems) <br /> pL t 2, 3. 4. <br /> 20,Designated Facility Owner or Operator:Caraficatien of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> d Day Ye <br /> EPA Form 8700-22\06V.12-17) Previous editions'are otlsdele. +; DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM, <br />