Laserfiche WebLink
IIIIIIIIIIIIIIIIIIIIIIIIitlllflllllll <br /> SSL SK SHIP# 220298614 0 0 5 9 2 3 9 6 5 5 IC S <br /> Please print or type.(Form designed for use on elite(12-pitch)typewnter.) Form Approved.OMB No.2050-0039 <br /> r UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Traeldng Number <br /> WASTE MANIFEST T X 8000081205 1 1-800-41--,B-1760 005523965 SKS <br /> 5.Generators Name and Mailing Address Generators Site Address(if different than mailing address) <br /> 'HFETY-KLEEN SYSTE^)S, INC. SAFETY-KLEFN SYSTEMS, INN- <br /> PA SOX Fj-`-;.. 5`10-56 SALIDA B! 111D <br /> SAL IDA CA 95368Generators Phone: r_ - - <br /> 6.Transpoder 1 Company Name U,S,EPA ID Number <br /> SAFETY-KL EEN SYSTENF, INC. rY,u4,11 �1E1S�` <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number <br /> SAFETY-KLEEN 3YS1EM=. <br /> LOW 88TH STREET <br /> SARAMENTTt <br /> Facility's Phone: <br /> ga 91b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes <br /> HM and Packing Group(if any)) No. Type Quantity Wt.Nol. <br /> 1. <br /> d <br /> r! FA <br /> LU 2. <br /> NTN-RCRA HAZARDOUS WASTE LIQUID, DM 1.34 <br /> (A'PUEOUS P€?RTS BASHER SDLUTION) (l1 <br /> 3. <br /> 4. <br /> 14,Special Handling Instructions and Additional Information <br /> TSD; CA SAL Sta: <br /> "i; HR EMERGENCY #1-e00-468-1760 :SK. TF_z; <br /> 1 ' R'SI S E ICA :f -d tsbf h I t a ovr rNoping name,and are classified,packaged, <br /> marked and labeledlplararded,and are in all respects in proper condition for transportaccording to applicable international and national governmental regulations.If export shipment and I am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)('d I am a large quantity generator (if m a small quanti necator)is We. <br /> ra rslOfferoes Prin d Name Sig re M th Day Y <br /> ti��£ 3" l <br /> -J 16.Intem tional S pments <br /> ❑Import to U.S. ❑Export from U.S. ort of trylexil: <br /> ? Transporter signature(for exports only): to ing U.S.: j4 Z <br /> w17.Transporter Acknowledgment of Receipt of Materials <br /> 7Fasp r 1 Pdnted/T Name Signatu Moth Day YAa� <br /> 130 <br /> QTr spotter 2 Prin /typed Name Signature Month Day Year <br /> C <br /> F <br /> 18,Discrepancy <br /> 18a.Discrepancy Indication Space ❑Quantity ❑Type ❑Residue ❑Partial Rejection ection Full Rejection <br /> Manifest Reference Number: <br /> 18b.Altemate Facility(or Generator) U.S.EPA ID Number <br /> J_ <br /> V <br /> 3 LL Facility's Phone: <br /> w 18c.Signature of Altemate Facility for Generator) Month Day Year <br /> a <br /> z <br /> y19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 1. 2. 3. 4. <br /> Nit;1 -7T-7�-j kt <br /> 20.Designated Fa" er or Operator.Certificabo f receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> PdnWUyped a Signature Month Day Year <br /> EPA Form 8700-22(Rev.3-05) Previouseditions are obsolete. 0ESIGNATED FACILITY DESTINATION STATE QF REQUiRE0) <br /> i ct j4941/tai 023 - <br /> A <br /> Page 19 <br />