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.teTii {{` _ <br /> DEC f <br /> a. lor s Phone CA 9 b 4 <br /> lQ b. Transporter t CompanyNama <br /> i US EPA um <br /> Stale Trrn*pprt�l�--� C, <br /> - Na - Q. ransportef• <br /> 7. Transporter 2 CompalNaw A. U8 EPA ID Number <br /> LState Tru1*pp►wlit r <br /> ranspwel*PIfOrN L rw,rbi <br /> �. Oealgnaied Feeiftty Name end Site F, T <br /> l0 <br /> e Address a <br /> u3 EPA ID Number t3 $feta Fa <br /> a SAFETY-KLEEN CORP. 7--le5 -01 r•� :.ter ; ?, -' <br /> 0 5030 SAL I DA BLVD <br /> 7 Z c <br /> A 7' ( 0 13 6 Ml I=actatty s Pttona <br /> • 11. US DOT Desianptlon 604udln Proper 12. Containers 13. Total 14 <br /> }J g p Shipping Name,Hazard Class,and ID Number) Quantity Unit r L <br /> Type Wt/VoJ �4 West* <br /> No. <br /> €� <br /> WASTE PE'TROLEU'M NAPHTHA tat* <br /> E° <br /> E b. t3tZSv37IE.E Li©uza ur� s5cDo0L ��crn X27 ) 741 <br /> V EPA10iher p <br /> ci R CJ <br /> A State <br /> T <br /> N O EPAISther <br /> 81aEe 5 <br /> CE d. EPAJ other <br /> 2 <br /> W Ststs.- '- <br /> CJ _ <br /> J. Additional Dascrlptiona for MatEPAJOlharerials Llafed.Shove <br /> I{A j D0317 K• Handling Code*fpr Wastes Hated llbovn <br /> tr, 041� _ .. � <br /> C, d <br /> d <br /> IS. Spacial Handling tnatructiona and Additional Informalion i <br /> 2 <br /> Er,4 <br /> ,ERGENY RESP#1-70(3-85a--466Og I�' 04 8�? 349 7-iF� -DY-3077 01 <br /> a SKDOT* A: 501 S. C: D: <br /> GENERATOR'S CERTIFFCATION, 1 hereby declare that the contents of this consignment are fully and accurately deacribed above by proper shiAping name <br /> and are classified,packed,marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and <br /> � <br /> national government regulations. <br /> Z I1 I am a large quantity generator,I certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined <br /> to be economically practicable and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the <br /> Present and future threat to human health and the environment; OR,if I am a small quantity generator.I have made a good faith effort to minimize my waste <br /> j generation and aelecl the best waste management method that is available to me and the I can atlord. <br /> J Printed/Typed Name <br /> �..+� rte- Month De r <br /> . ]�' ✓/ G <br /> j T 17. Transporter 1 Acknowledgement of Receipt of Mafedala <br /> R <br /> A Printed I Typed Name - <br /> N �r f tSignature <br /> S Noel horint Manr p Y <br /> P <br /> O 18. Transporter 2 Acknowie(geman4 of Receipt of Materials .00 <br /> R <br /> Printed/Typed Name <br /> E Signature <br /> Month Day Year <br /> 19. Macrepancy Indication Space I <br /> F <br /> A <br /> C <br /> I <br /> I <br /> 20 Facility Owner or Operator Certification of receipt of hazardous materials covered by his anifesi ex apt as noted in item 19, <br /> T <br /> y Printed!Typed Name <br /> 9 8422 A Signature <br /> Clark E. Hill M nth Day ar <br /> / <br /> A e7130--22 Do Not Write Below This Line <br /> ev.6-$9}Previous editions are obsolete. <br /> Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS <br />