Laserfiche WebLink
A9t. SK SHIP# 222941995 1111111111111111111111111111111111111 <br /> Please nntor 0 0 6 1 3 6 5 2 0 S K 3 <br /> p type.(Form tles netl to use on elAe(11yMch) 'erJ Form Appmwd.OMB No.2050-0038 <br /> UNIFORM NA2ARDOU3 1.Genenmr ID Number 12p i of g.Emergency Response Prynne_ d.Manifest Tracking Ru <br /> WASTE MANIFEST T%R0000A 1205 1 1 ��� <br /> S.GetMmN.Nag .nomYrNAtlGees Ganerato's Site Aatlre..fdtlMbmnitlMn mailirG adtlr6 <br /> 136520 SAFETY-KLEEN SYSTEMS, INC. -KL EN SYSTEM`-y tnii:. <br /> F BOX ., ,5 `1 ', 4pLIDA SLUO <br /> SALI DA CA 95568 <br /> Garorecnwmre, 209-545-1011 SA(_D)A <br /> CR 95368 <br /> 6 cm�s� US.EPA IDNumber <br /> �� 11—KLF:1•�wSYST[NS INC T%R000NPd05 <br /> T.RanapMx 2 CMnpanY Name <br /> U.S.EPA IV Numher <br /> 8,0eagneed FatilMy Nerve am sire address SAFETY—KLEEN OF CALTFORNIR <br /> U.S.EPA IDNumGr <br /> EPSP SMITH AVE. <br /> 510-794-4400 NPWARK , CA 945691 <br /> .ah e.Prone: CAD9A0SS7418 <br /> 4, W US,DOT DesMption lmNWYN Pmpar Wng W.,Naastl LM..IDNmnbec 1g.Cmlar,ms 11,TMd 12.Unn <br /> HM antl Pad*G=P(# A) No. TYPe Ouangry YANd. 13.WesMCatlas <br /> 1 NUN--RCRA HAZARDOUS WASTE, LIr7UID TT , 2) <br /> o (USED H1L) <br /> Ob1 3 S <br /> w <br /> cg <br /> 3. <br /> a. <br /> ta.SPeaal HanGirp InabutaoreaMPdmMonal lnlgmaupn T<;n1 EVS GAI. CSF; 1 <br /> 24 HR EMFfi FNCv 41-800-468-1760 fSK / TFT) <br /> PITH AS "PRE T—FOR" RY ,'N TO RETAIN '.FN"F oLIB CPRJEr'SAA NFC 9 ARY <br /> 15. GENEMTdt'SIOFFEROR'S LE0.0FIGTON� IMrebydeWmnMtle mnrems ofiM1ie areignmeM eregtly aM ecanrerydescnbetl eboveby Vepoper abippirg renre.aN ere Waegad.Dackagea, <br /> maMM aM labelediplerarded,aMeranell respecrs in pmperwMiGon brimnsponaaortlirg to applicable lnlemationalantl retlonal govemmenrel regubtans.Herporl NipmeMantllemtln Primary ' <br /> ExpMer,I rmrfy Wt Me cmrenLa Monis mnsgnment mnbnn N ga bans of tice a1redM EPAAdmwredgmenlof DorrseM <br /> IORNy1M1et Newase minim'rzatla sMremeMitlenuhM in aO CFR P6221(al lgl amaleyequangryganemlorlal5 GI s.ma�l quanutygeriemW)M We. <br /> Ganem Pnnted?yped Name SMrabre Mmitl1 DeY Year <br /> c1©8 D? 117 <br /> 16.Imemauonal6 ipmanes ❑Inn uhtous ❑ vwry U.S. Pmtolen hon: <br /> 2 Tmnsponer sgneture 0a eepore only)'. Derel LLS: <br /> 11.TmnspwrrAMr W,nent of Receipt or Mennen <br /> O Tmnspmimi "nreNFyp=Name S,gwere M�o�nTtyQ� NY Year <br /> aTmrm x not ypad Wme Sgnebue Monts OaY YeR <br /> z <br /> 16.Dwcparmy <br /> 18a.DiecnPnol lrMbagon Spa. ❑ Quant, ❑TT ❑Reed. ❑Perbl Ryetion ❑Fu4 Releown <br /> 10b AMerrare fadNty(a Genmatal Manifest Rereren®NmMer ' <br /> LLs.EPA IV WmbR <br /> U <br /> sQi FatlIMYs Pnone: <br /> W 1&.1A. ofAMemMe F.dN,(or Gerernw) Mbnth Day Year <br /> 6 <br /> 2 <br /> N19 Rewdous Wase Ryon Me-P-nt Me" I.woes W M1erenionexmW Yeamwll,OsWael,ab recyGing s,stend) ' <br /> C 1. l J� 2. 3. a <br /> 20.Das�ynaledrY53"), <br /> ( 0wmor Opemta:Cedgee5on MmcdMMM1areNwemaerebmremd Mme men"otaxtuDt e.Med n <br /> P. _/ Stere MMM1 , earForm870622 Pr ous atlitionsareo e. DESIGNAT AGILITY TO DESTINATION STATE(IF REQUIRED) <br />