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SSL SK SHIP# 232179997 111111111111IN 1111111111111111 <br /> 007771366SK8 <br /> Please print or type. Form Approved . OMB No , 2050-0039 <br /> UNIFORM HAZARDOUS 1 . Generator ID Number TXROOOZ81205 2. Pagell of 3 . EmeAy9rlGy R$smAse Eh @ 4. Manifest Tracking Number <br /> WASTE MANIFEST 1 [SrOitl isO 1 � h 007771366 SKS <br /> 5 . Generators Name and Mallin Address Generators Site Address `if different than mailin address) <br /> SAFETY - KLEE►J� SYSTEMS , INC . SAFE TY—Kt_EEN SYSTMS , INC . <br /> PO BOX 555 5050 SALIDA BLVD <br /> SALIDA CA 95368 <br /> Generators Phone 209-545- 1011 SALIDA CA 95368 <br /> 6 . TgAppdecll.Cagggnut _V SYSTEMS INC U . S. EPA ID Number TXR000081205 <br /> 7 . Transporter 2TComppannyy Name U .S . EPA ID Number <br /> CLEAN HARBORS ENV SVC INC . MAD039322250 <br /> 8 . Designated Facility Name and Site Address TFER140 FLUIDS INC U .S. EPA ID Number <br /> 12533 BE CARPENTER DR <br /> CLACKAMAS , OR 97015 - 8988 <br /> 503-78H-4616 tlR125197 <br /> Facility's Pholw: <br /> ga Sb. U .S . DOT Description (including Proper Shipping Name , Hazard Class , ID Number, 10. Containers 11 . Total 12 . Unit <br /> HM and Padding Group (if any)) No. Type Quantity Wt.Nol . 13 . Waste Codes <br /> 1 . NtlN— RCRA HAZARDOUS WASTE SOLID DM P 223 <br /> o ( DRAINED / UNDRAINED USED bIL FILTERS ) <br /> w <br /> 2 <br /> 4 . <br /> 14 . Special Handling Instructions and Additional information TSD : TPO SAL CSG : <br /> 24H EMERGENCY # 800 - 468 - 1760-CH / SK / TFI -Contract retained by generator confers aggency authori y <br /> on initial transporter to add or substitute additional trans Grters on eneratorcls behalf . <br /> 15. GENERATOR' SIOFFEROR ' S CERTIFICATION : I hereby declare that the contents of this consignment are fulty and accurately described above by the proper shipping name , at are classified , packaged , <br /> marked and Iaheadlplawreed , and are in all respects in proper condition for transport according to applicable international and national governmental regulations . If export shipment and I am the Primary <br /> Exporter, I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Cqnsent <br /> certify that the waste minimization statement identified in 40 CFR 262 .27(9) (if I am a large quantity genera ) or (b) ( am a sm ntity generator) is tme. <br /> Generator'srOffemes Pn /Typed NSignet Month Day Year <br /> 16 . 1rfternafiona ents <br /> r ❑ Import to U .S. ❑ Ewe from U . S . Portof entrym it: <br /> '= Transporter signature (far exports only) : Date taving U .S . : <br /> W IT Transporter Acknowledgment of Receipt of Materials <br /> K Trans er1 PrintedR Name Signature Month Day Year <br /> O <br /> d <br /> QTranspo PrintetllTyped Name Signature ( 1 onn Day Yedr <br /> fGl � d <br /> 18 . Discrepancy <br /> 18a . Discrepancy Indication Space ❑ Quantity ❑ Type ❑ Residue ❑ Partial Rejection ❑ Fell Rejection <br /> Manifest Reference Number. <br /> 18b. Altemate Facility (or Generator) U . S . EPA ID Number <br /> J <br /> V <br /> LL Facility's Phone : <br /> W 18c . Signature of Alternate Facility for Generator) Month Day Year <br /> Q <br /> 2 <br /> y19 . Hazardous Waste Report Management Method Codes (i .e. , codes for hazardous waste treatment, disposal, and recycling systems) <br /> 2 . 3 . 4 . <br /> 20 . Designated Facility Owner or Operator: Certification of receipt of hazardous materials covered by the manifest except as noted in Vern 18a <br /> Printed(Typed Name Signature Month Day Year <br /> ( Ito Lot <br /> EPA )Form <br /> 8700-22 72676 / A56 ) 3e ous editions are solete . DESIGNATED FACILITY TO EPA ' s e • MANIFEST SYSTEM <br />