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3SL GR SHIP* 220683437 <br /> Please print or type.(Form designed for use on elite 12.01cA)p4eetiler.) Form Approved,OMB No,2050-0039 <br /> UNIFORM HAZARDOUS ,.Guunmr,UomSer ZP +d 3E x e O.ManHeet Traclin Xumbx <br /> WASTE MANIFEST TXR000081205 1-6rsv_ F -10 n057�810 SKS <br /> S.GmumtarNameam Mediiq MdM Gemral altmM amIdRerent Nm rtuNmaoul <br /> SAFETY-Rt.EEN SYSTEMS, INC. SAFETY-HLEEN SYSTEMS, INC. <br /> PD BOX 555 5050 SRLIDR BLVD <br /> SRLIDR CR 95368 <br /> Gemmi pwa. 209-545-1011 SALIDA CR 95368 <br /> a.T9&V%'Mmrndeme SYSTEMS, INC. U.S.EPA ID Nial TXPW0081205 <br /> TTrempMer2Gaioaaryy�XaRme US.EPAIDNumxr <br /> s.Dmgrulm Faoiiq Nameard SiMMdmx THERMO FLUIDS INC U.S.EMIDNmnl <br /> 4301 W JEFFERSON ST <br /> PHOENIX ,�, AZ 8511 <br /> 800-350-7565 RZA00a003681 <br /> Fad aPbam: <br /> ga, 9b.US.DOTDawipm(bdalin9Pm Sb ft Nama,HazaU CLASS IO NwMa'. 10 PmMNeu 11.1dd 12.Una <br /> HM aM Pa]ting Gaup laarcy)) No. TWamny VANd. 13.Wade Cptles <br /> Ym <br /> + NUN-RCRR HAZARDOUS WASTE SOLID DM P 283 <br /> ED <br /> o (DRAIN /UNDRAINED USED bIL FILTERS) <br /> w <br /> a. <br /> +a.Smao,l H.mlag Nsmmams am AmMww mmmemn TSDa TPR SHL CSG: <br /> 24 HR EMERGENCY N1-800-468-1760 (SH / TFI) � I� 'x f 0 <br /> RUTH AG AGENT-FOR" BY GEN TO RETAIN LICEIQ5ED <br /> 15. GENERATOR'meup RDWr,and am in all X: Nweby Uedere Nat Ne mr#MadlMamvgnireMau NryaMacr anam! xaNaCebore Gy Mepopva5ipgprwm.edea tlm.ft Pool tl, <br /> markM eM IebeleNplamMetl,and ere in all respedsin prgaamdliaariw OanspwlamntlirgmapplireNe IntemefipnelaM mtluW 9prnnmmMl reAtlMEarsc NelmmtsNipmmlaM I am Ne Primary <br /> EspMer. ceN1y Nat Ne aMeMe of Nis mnsgnmml mMwm N Ne Mrms pI Ne atlecfled EPAAdmo-Meapmmt d COFmnL <br /> I mrNy Nat tlmxasM miMmtraapnsMtement itlerNaetl M49 CFR2a2.3y(a1ltllamelryequeMay pemreNrl oral lel ama 9enemNg4Nre. <br /> Gem 'MaNYmd N" SiMuhue Mmtb Day Yxr <br /> F I.Irmaroll SYiipmenmi ❑Inlpadb U.S. ❑apm hpmQl.S:'� PatdeMrymak <br /> Tumpgmrsgmwre llaeapahpNyl: <br /> Dare all U.S.: <br /> w 1p.iuneponerOdmMaERmmd RemiMdMeMisls <br /> C T iP' ed?ymtl Name S- MoroN Day Year <br /> 1 u) IN <br /> TMnµnmr3 PrMMNf,pb Nemo - re MmM <br /> OR Year <br /> }I 16.0umepanry / <br /> I 18a.Dpgexmy lMbam Spars ❑ Goom, ❑Type ❑Rmtlm ❑PaNal RaRNon ❑l Rejection <br /> Menaest l¢hmom NwMer, <br /> 18b P1MmnM Fau4y lw Gxerelw) US.EPAIDNembm <br /> J <br /> U <br /> LL FaalR/¢%me: <br /> saw„ 1&.SipmNreofANemde Fadlity(m Gemubr) MaM Day Year <br /> 2 <br /> H19.Haarapue Waste HepmlMne9emanl Matlm0Dotlx(.e.,mdeabrhrmdaewesletreatmenl,dapmd,aM rwryr,im systems) <br /> 2. 3. a. <br /> 2D.Da&9nah0 Fardlry Owrer n Opeub:feNncaMn d remipt d nazartbue nulmials mrereE nY Ne manilml exmPt as Metl N Imm,Ba <br /> PmrbQ? Name SgnaW� :.rte.` Monty oav rear <br /> EP�f�✓jJA0g2nous editions ere obsolete. DESIGNATED FACILITY'S COPY <br />