Laserfiche WebLink
SK SHIP# 231386713 HIM 111Elll111111lll1111111INIII <br /> Please print or type. 0 0 7 4 7 b 9 0 0 S K 5 <br /> Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generetor 10 Number 2,Pagest of 3.FTmepp R 7e P ope,_ 4.Manife'stt Trackin Number SKS(� <br /> WASTE MANIFEST T. RL�0f�081 �'' h O O ! 4 7 6 9 O O SKS <br /> 5.Generator's Mame and Mailing Address Generator's Site Address(if different than mailin address) <br /> SAIETY—KLEFN SYSTEMS, INC, SAFETY—KLEEN SYST MS, INC. <br /> 9ALRTDfl S55 CA 95368 5050 SALIDA BLVD <br /> Ger1emborsPho 209-545-1611 SAL IDA CA 95368 <br /> 6.Tr,q r} ,y ft SYSTEMS INC U.S.EPA ID Number <br /> 7 �tt1Y TXr@0 01219]�.,a` <br /> 7.Transporter 2 Compan Nam U.S.EPA ID Number <br /> C1..EANI HA RCfRS FNV SVC INC. MAD039322250 <br /> 8.Designated Facility Name and She Address THERMO FLUIDS INC U.S.EPA ID Number <br /> 1x533 SE CARPENTER DR <br /> � OR 97>2f15-8388 ORPO00025197 <br /> p8--46 3 E <br /> Facility's Phone, <br /> ge_ 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12,Unit <br /> HM and Packing Group(if any)) No. Type Quantity Wt.Nol. 13.Waste Codes <br /> 1 NON—RCP,A HAZARDOUS WASTE SOLID <br /> o (DRAINED/UNDRAINED USED bIL FILTERS) / <br /> w <br /> z 2 <br /> r., <br /> c� <br /> 3. <br /> 4, <br /> 14.Special Handling Instructions and Additional Information TSD TSU 5Al_ <br /> r ceps <br /> '4H EMERGENCY#800--468-1760–CH/SK/TFI–Contract retained by generator confers aggenvy authori On initial transparter to add or Substitute additional tram orte-..=. rn - enerator's beha'_f_ <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION:I 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 labeledlplacarded,and are in all respects in proper cur ifion for transport according to applicable international and ational 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 Consent. <br /> I centy(hat the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator) (b)(if I am sural uan generator)is true. <br /> Ge eratoeslOtferor P tadJ ped Signatu Month Day Year <br /> IIIt)L,.N — I u (J, , – I <br /> J 16,Intelm`alional Shipments <br /> H ❑Import to U.S. ❑Export from US, Portentrylexit: <br /> Transporter signature(forexports only), Date aving U.S, <br /> W 17.Transpoder Acknowledgmentof Receipt of Matenals <br /> Trans rter 1 PrintedlTy N me Signature _ Month Day Year <br /> O <br /> a <br /> Z Transporter Pdnted7Typed,ullie SignatureMonth Day Year <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space Quantity ❑Type ❑Residue ❑Portia[Rejection ❑Full Rejection <br /> 18b.Alternate Facility Reference Number:lity(or Generator) U.S.EPA ID Number <br /> J <br /> V <br /> LL Facility's Phone <br /> W 18c.Signature of Aherrate Facility(or Generator) Month Day Year <br /> a <br /> z <br /> y 19.hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste <br /> treatment,disposal,and recycling systems( <br /> p 1 L 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 /> Pdntedl7yped Name Signature Month Day Year <br /> Sf=q";•,> I 1 15-1?-,?12d <br /> EPA Form 8700.22((Rev.12.17) Previ s editions are obsolete. DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM <br /> 1)787267E,;`.1`.,E.t�33 <br />