COMPLIANCE INFO_2019 - Laserfiche WebLink

Home Browse Search

SSL SK SHIP# 224323466 11111111111111111111111111111111111111111 0 0 6 1 0 1 2 3 9 S K 3 Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 1.Generator ID Number 2.Page 1 of Emery cy f�sons P 4.Manifest Tracking Number UNIFORM HAZARDOUS TXR000081205 A —Bb —'* tl—� I�� 006101239 SKS WASTE MANIFEST !+ 5.Generators Name and Mailing Address Generators Site Address(if different than mailing address) SAFETY-KLEEN SYSTEMS, INC. SAFETY-KLEEN SYSTEMS, INC. PO BOX 555 5050 SALIDA BLVD SALIDA CA 95368 Generators Phone, 209-545-1011 SALIDA CA 95368 6.Trans der 1 Company NaU.S.EPA ID Number SAFETY-KLEyme EN SYSTEMS INC TXR000081205 7.Transporter 2 Company Name U.S.EPA ID Number CLEAN HARBORS ENVIRONMENTAL SVC INC. MAD039322250 8.Designated Facility Name and Site Address THERMO FLUIDS INC U.S.EPA ID Number 12533 SE CARPENTER DR CLACKAMAS , OR 97015-8988 503-788-4616 OR0000025197 Facility's Phone'. go. 9b.U.S.DOT Descnption(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13 Waste Codes HM and Packing Group(if any)) No, Type Quantity Wt.Nol. ' NON-RCRA HAZARDOUS WASTE SOLID DM P 223 or (DRAINED/UNDRAINED USED bIL FILTERS) ' q (� � d-,/`' Lu 2. W W 3. 4. 14.Special Handling Instructions and Additional Information TSD:TPO SAL I � I CSG: 24 24 HR EMERGENCY #1-800-468-1760 (SK / TFI) "Y" IAUTH AS "AGENT-FOR" BY GEN TO RETAIN LICENSED SUB CARRIERS AS NIECE � 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, marked and Iabelecilplacarded,and are in all respects in proper corki for transport according to applicable international and national governmental regulations.If export shipment and I am the Primary Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator(or(b)(if I am a small quantity generator)is true. Generator I roes PrintedRyped a Signature Month gqDa�yy Year r 13 G(7 1U t . neminonal Shipments F ❑Import to U.S. ❑Export from U.S. Port of entry/exit Transporter signature(for exports only): Date leaving U.S.: W 17.TransporterACknowledgment of Receipt of Materials Tmnspo r Pri dfTyped Name Signature Month Day Year a N G Tran erg PrintedlTyped a,rae //JJ Signature f 001' t Month Day Year 121!19 /„�q-.PLis)n 3 d Vg 18.Discrepancy t 18a.Discrepancy Indication Space El Quantity ❑Type ❑Residue LlPartial Rejection ❑Full Rejection Manifest Reference Number: 18b.Altemate Facility(or Generator( U.S.EPA ID Number J U LL Facility's Phone: yC11j Ii Signature of Alternate Facility(or Generator) Month Day Year Q z 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 1. I 2. 3. 4. NI 20.Designated Facility Owner or Operator.Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Primed(yped Name Signature Month Day Year er1 + E1PA Form)78782700-22 67611560 Pre ous editions are obsole e. DESIGNATED FACILITY TO DESTINATION STAT (IF REQUIRED)