COMPLIANCE INFO_2019 - Laserfiche WebLink

Home Browse Search

SSL SK SHIP# 227725679 0 0 6 9 5 9 6 2 0 S K S Please print or type. Form Approved.OMB No,2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 5 2.Page of 3. mer Re e P 4.Manifest Tracking Number WASTE MANIFEST TXRit+000812Q+� —� — � — °�� 1006959620 SKS 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) SAFETY-KLEEN SYSTEMS, INC. SAFETY-KLEEN SYSTEMS, INC. PO BOX 555 5050 SALIDA BLVD SALIDA CA 95368 Generator's Phone: 209-545-1011 SALIDA CA 95368 6.Traq;ofV.TRL,�EA SYSTEMS INC U.S.EPA ID Number TXROOOO81205 7.Transporter 2 Company Name U.S.EPA ID Number CLEAN HARBORS ENVIRONMENTAL SVC INC. MAD039322250 8.Designated Facility Name and Site Address SAFETY-KLEEN SYSTEMS, INC. U.S.EPA ID Number 6000 88TH STREET Facility's Phone: SACRAMENTO , CA 95828 916-386-4913 CA0000084517 9a 9b.U.S.DOT Description(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. a 13 UJ 2. NON-RCRA HAZARDOUS WASTE LIQUID I DM ZU G 134 (AQUEOUS PARTS WASHER SOLUTION) 4(1QdE9u8 4"T.1; WASFf�fF-SQ�T�A��------$ -- 4. 14.Special Handling Instructions and Additional Information TSD:SCA SAL CSG 24H EMERGENCY#800-468-1760-CH/SK/TFI-Contract retained by generator confers a ency authori y an initial transpnrtar to add or suhstitutp additional transpcirtgr% on Up hphalf- 15. GENERATOR'S/OFFEROR'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 labeled/placarded,and are in all respects in proper condition 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 EPA Acknowledgment 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's/Offerors Printed/Typed Name Signature Month Da Year Sq A J 2.LCki :A i s J 16.International Shipments H ❑Import to U.S. ❑Export from U.S. Port of entry/exit: ? Transporter signature(for exports only): Date leaving U.S.: W 17.Transporter Acknowledgment of Receipt of Materials LLJ Transporter 1 Printed/Typed Name Signature Month Day Year a S' �NLc R-tt, 71� .8 C�—Gh-- LZ l8 i Z Transporter 2 Printkdgyped Name Sig Ze Month Day Year 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantityt ❑Full Rejection El Type ❑Residue Partial Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number J V LL Facility's Phone: w 18c.Signature of Alternate Facility(or Generator) Month Day Year a Z N19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) LU 1 +4A+ �- 2' H141 3. �}#t-—'k- a. 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Printed ed NameZOA�2 Signature Month Day Yearm 870022 Rev12-17) Previoueditions are o solete. ESIGNAT�_ED-FF-jACILITY T PA' -MANIFEST SYSTLM 2) 14941/156023-3` 44�' ' "96@2ii rr-- �