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i� <br /> "MJt► 3� <br /> T ON <br /> 4. Gener}tors Phots Q09) 4-2303 <br /> ti. Transporter t Company Name 0. US EPA ID Number <br /> ? SAFETY--KLEEN CORP. JAJT ["O*t2160 I I I SOU <br /> T. Transporter 2 Company Name d US EPA ID Number a Trer+sportwll„ <br /> 1g <br /> c <br /> 3r era Phrom,t <br /> 9. Designated Facility Name and Site Address ICY. US EPA ID Numbs[ -.$tate Fates q <br /> SAfiE CY—KLEEN CORP. ?��BS-•OL 7,. c, 3 g` :: <br /> 5050 SAL I DA BLVD It rFac9x�s#Kiaeto ;} t, � 3, a <br /> <_ SALIDA, CA gbB CAT OQQ6Y34b8 •tri <br /> fi 12. Containers 13. Total 14. t. <br /> � !0 11. US DOT Deacnption(Including Proper Shipping Name,Hazard Class,and fD Number) ttli <br /> Quantity Vett safe No. <br /> LL �yt tt1� Ll�r'f Na. Type yift/YDI s ?• <br /> Lo< WASTE PETROLEUM s i7 'n KA r• 9tstll 41. <br /> z COMBUSTIBLE LIQUID VN1255=01 ) (ERQ i 7) D � EPArather rrR��ryyy <br /> ay <br /> rs` E r•' VV♦ <br /> E b4 <br /> FPAiMW <br /> LN <br /> arc, <br /> r',1 tEPAi <br /> Uj ct: d. State <br /> w TEPA 100w <br /> U - <br /> LU J. AddiNortei Descriptions foc ktateriale Listed Mors IL t arxiliing Codes fDr Wastes Listed Above <br /> © 1 (A) 1)03'? DO 1� tt,� :gip .1r� a��a�� � �' �y t�.. <br /> i6T R;`>w r V t �H4. " a4 �14 <br /> UL <br /> 15. Spacial Handling instructions and Additional Informafiort 9045 20/! 34192 7,,,,I8f5-01-307'�7 01 � <br /> Z EMERGENCY RESM—708—$ —4660 -1-- .—. '-i..i--- <br /> $KDOTO A: 501 B: C: D: <br /> J <br /> J <br /> U 18 <br /> GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are tuty and acCuratefy described above to appl ppropericable intternaempshippo name <br /> and are ctestified,packed.marked,and labeied,and are in all respects in proper condition for transport by highway according ltional and <br /> d national government regulations. <br /> If 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 /> O present find future threat to human heahh and the environment;OR,It t am a small quantity generator,I have made a good faith effort to minimize my waste <br /> } generation and select the beat waste management method that Is available to me and that I can afford. <br /> - - - Monrh DaY Year <br /> iJl PrintediTyped Name Signature <br /> � <br /> t W T 17. Transporter 1 Acknowledgement of Receipt of Materials <br /> R <br /> Z <br /> A Printed/Typed Name Signature Month Day Year <br /> U. S Roel Thornton <br /> 0 P <br /> D 18, Transporter 2 Acknowladgement of Receipt cf Materials <br /> qA Printed�Typed Name Signature month Day Yea: <br /> U T <br /> E <br /> Z ' <br /> 19, Discrepancy Indication Space - <br /> F <br /> A <br /> C <br /> I <br /> L <br /> 1 20. Facility Owner or Operator Certification of receipt of hazardous materials coveredA <br /> by this andest except as no <br /> in Item 19. <br /> T <br /> Printed! ed Name Signature <br /> ClMonth Day Y <br /> Clark E. Hill l <br /> DHS 8022 A Do Not Write Below This Line <br /> EPA 8700-22 <br /> (Rev.8.89)Previous editions are obsolete. <br /> Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 OAY`. <br />