Laserfiche WebLink
SSL SK SHIP# 230759611 X �Y/w 11111111111 11mil111IN <br /> Please riot or 0 0 7 3 1 4 6 7 7 S K S <br /> P tYPe Form Approved,OMB No.2050--W39 <br /> UNIFORM HAZARDOU5 1.Generator 1D Number TX R00$081205 12.18goi of 3.Emr4g�yy R,espppge PJp&@ 4.M ik SKS <br /> WASTE MANIFEST 11 t31IL�U0O `rrGE7 1 <br /> 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) <br /> SAFETY-KLEEN SYSTEMS, INC. SAFETY-KLEEN SYSTEMS, INC. <br /> PO BOX 555 5050 SALIDA BLVD <br /> SALIDA CA 95368 <br /> Generator's Prwoe: 209-545-1011 SAL I DA CA 95368 <br /> 6.T%X21!0 r, T SYSTEMS I 14C U.S.EPA ID Number TX R698081205 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> B.Designated Facility Name and Site Address SAFETY-KLEEN OF CALIFORNIA U.S.EPA ID Number <br /> 6880 SMITH AVE. <br /> NEWARK , CA 94560 <br /> CAD9N887418 <br /> 510-795-4400 <br /> Fadli s Phone: <br /> ga 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes <br /> HM and Redoing Group(if any)) No. Typo Quantity Wt.Nd. <br /> 1. NM-RCRA HAZARDOUS WASTE, LIQUID TT G 221 <br /> o (EASED OIL) <br /> 9 2 Dot DOD <br /> L <br /> to <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional Information TSDeEVG SAL CSG: l <br /> 24H EMER6ENCY#800-468-1760-CH/SK/TFI-Contract retained by generator confers a envy authority <br /> n initial <br /> 15. GENERATOWSIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are dassifled,packaged, <br /> marked and labeledlplacarded,and are in all respects in proper condition for transport according to applicable intemational 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 EPA Aduawledgment of Consent. <br /> I certify that the waste minimization staterrient identified in 40 CFR 262.27(a)(if I am a large quantity generator]or(b)(if I am aan*generator)is true. <br /> Generstoes! s PrintedlTyped Name SignatureMonth Day Year <br /> , / , ~ &//-:� 101� V 14?JD <br /> 16.International Shipments <br /> ❑Import to U.S. ❑Export from U.S. of anfrylexit: <br /> Transporter signature(for exports only): Date leaving US.: <br /> W 17.TransporterAcknowledgment of Receipt of Materials <br /> LU <br /> [- Transporter 1 rtedlTyped Name Signature Month Day Year <br /> /- <br /> TransWer2 PnhWypedName Signature Month Day Year <br /> }- <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Mandest Reference Number. <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> .r <br /> V <br /> Fadlity's Phone: <br /> LU 18c.Signature of Altemate Facility(or Generator) Month Day Year <br /> N19.Hazardous Waste Report Management Method Codes{i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> LU 1. ` � � 2. 3. 4. <br /> 20.Designated Facility Owner or Operator.Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> PdntedrTyped NameSignature Month Day Year <br /> k 61,A- C, v rL3 I Z <br /> EPS r 18 2(Revs.112-7� Previous editions are obsolete. DES ED FACILITYTO EPA's e-MANIFEST SYSTEM <br />