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SSL SK SHIP# 226758772 11111111111111111 gill <br /> Please pro066f6i44SKSnt or typo. Form A proved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Gereror ID NutieT8R00013 bw <br /> WASTE MANIFEST <br /> 0mR4ohW1"00664'6644 <br /> 5.Generelors Name end naaiF Address GeremlofsSrwAuoress�(Mo��a_went than malt address) <br /> SAFETY-KLEEI� MTM, INC. SAFETY-UEN SYSTEMS, INC. <br /> S�ALBOXX 555 95368 5050 SALIDA BLVD <br /> Generator's Phone: -1011 SALIDA CA 95368 <br /> "TrOW69%'120 SYSTEMS INC Us.EPA ID Number 7X 1205 <br /> 7.Trdrrsyoder 2 Nanre U.S.EPA ID Number <br /> cLF� 'WWF1s ENVIRmwNTAL Svc INC. MIADe39322M <br /> B.Designated FadRy Name and Site Address SAFETY-KLEEN SYSTEMS, INC, U.S.EPA ID Number <br /> 6000 89Th STREET <br /> 916-366-4913 SACRAMENTO + CA 95828 CA0000084517 <br /> Facititys Phare: <br /> >m, 9b.U.S.DDT Description(including ProperShippirg Name,Hazard Clew,10 Number, 10.Offla ars <br /> and Paddng Group(deny)) Na. Type 1puantlly 011W. 73.Waste Codes <br /> Ix f <br /> QO <br /> C <br /> W 2. NDN-RCRA HAZARMW WASTE LIDUID 1 ON 't ca 6 134 <br /> (AQIJEOUB PARTS WASHER SOLUTION) <br /> 3. NON-RCRA HAZARDOUS WASTE(AQUEOUS PARTS WA%ERR SOLITfION)D l DF 'L c B 134 <br /> 4. <br /> 14,Special Handing Instructions and Additional Irdvmalion TSD:SCA SAL CSB: <br /> 24H EMEROR CY#8ft-468-1760-CH/SK/TFI-Contralct retained by generator confers a ency authori y <br /> on initial transporter toadd or substitute a ti trans or 's <br /> 15. GENERATGR'WFEROR'S CERTIFICATION:I hereby declare that the contents of this consignment are Uy and a=m*described above by the proper shipping nems.and are dasafred,pgol agad, <br /> marked and labeled/plecarded,and are in all respects in propernwcftn for transport awx*g to appkoble intemavorraland rational <br /> Exporter,I=thatthe cmtm fs of Ihls consignment conform W the tears of the attached EPA governmental regulatione.6 export sh pment and I am to Prknery <br /> I car*OW ore waste minimhafion slztemamt Identified in 40 CFR 262.27(6)Of I am a AUugWetlgmenof r <br /> a <br /> �9�crY generator) r� I small ggnOy eratotj Is tae. <br /> Gerleram�sJOde nf�Name.,—;, Signature Month Day jYear <br /> 1 ramelionel Shlpmema <br /> E ❑Import to U.S. ❑E1Oartfropi U.S. Ptxtof entlyleait: _ <br /> ` Transporter signatum(for exports omy): Date leaving U.S.: <br /> K 17.Tmns"Admavlaogmenf d Recdpt of Malerlala <br /> 0 1 Y Hama SigneNm MOMh Day Year <br /> CL <br /> 1Z Z <br /> T 1ed/Typea Name Montlr Day Year <br /> r18.Orevepa1v4 <br /> 111a.DSnepancy rndcafion Space ❑0.* ❑Type ❑Residue ❑Pm9el Reladbn ❑Full R*ction <br /> Mani Refemnce iMnnber. <br /> 16b.ABemate Facility(or C*wrator) U.S.EPAID Number <br /> J <br /> Ca <br /> FecilsYs Phone: <br /> 18c.Slgnaeae'Artemasa FBcliIfy(arGenerator) nth Day Year <br /> Y <br /> h19.Hazardous Waste Report Management Method Codes(i.e..nodes for hazardous waste beaanern,dispose,and recyafimg syslams) <br /> W <br /> z H141 3. W141 4. <br /> Za.Designated Faa V owner ar Operator:Certi4ratlon of mo*ilt of razerdous matelots mverd ty tto man"excW as naE in bm l6e <br /> ypad Na .gyre Month bay ,(wr <br /> EPAF D022Rev.92-17yptevbusedeonsareobsolete. DESIGNATED F ILI 0EPA7se-MANIFESTSYSTEM <br /> Y*�3 2)14941/1563 3)149411356023 <br />