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SSL SK SHIP# 228634279 11� �II�I��g111I11N� 1 � <br /> Please. rintortype. 0 0 6' 0 1 i!B K i <br /> Form Approved.OMB No.2050-0039 <br /> 11H1F0RE HAZARDOUS 1.Generator ID Number 2.Page 1 of 3. m R s P 4.Manifest Trackin Number <br /> WASTE MANIFEST TXR@@@@81205 1 � ��►��1 1006960188� SKS <br /> S.Generators Name and Mallin Address Generator's Site Address(itdifierent than mailing address) <br /> SAFETY—KLEEI� SYSTEMS, INC. SAFETY—KLEEN SYSTEMS, INC. <br /> PO BOX 555 5050 SALIDA BLVD <br /> SALIDA CA 95368 <br /> Generator's Phone: 209-545-1011 SALIDA 8 <br /> 9536 <br /> 6.Tr uleryyTny,biype SYSTEMS INC - i U.S.EPA ID Number CA CA 9536812@5 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> CLEAN HARBORS ENVIRONMENTAL SVC INC, MAD039322250 <br /> 8.Designated Facility Name and Site Address SAFETY—KLEEN SYSTEMS, INC. U.S.EPA ID Number <br /> 6000 88TH STREET <br /> SACRAMENTO , CA 95828 <br /> 916-386-4913 <br /> Facility's Phone: 00084517 <br /> ga. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 0,Containers 11.Total 12.Unit <br /> HM and packing Group(if any)) 13.Waste Codes <br /> No. Type Quantity Wt.Nol, <br /> 334 <br /> QO <br /> K <br /> W <br /> z. NON—RCRA HAZARDOUS WASTE LIQUID DM G 134 <br /> (AQUEOUS PARTS WASHER SOLUTION) <br /> a. <br /> 14. pecial Handling Instructions and Additional Pormabon TSD:SCA SAI. <br /> CSG; <br /> 24H EMERGENCY#800-468-1760—CH/SK/TFI—Contract retained by generator confers a ency authori <br /> on i r Y <br /> 15. GENERATOR`5lOFFEROR'S CERTIFICATION: hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are Gasified,packaged, <br /> marked and labOedlplacarded,and are in all respects in proper condition for transport according to applicable intemation and national governmental regulations.If export shipment and am the Primary <br /> Exporter,I ceNfy that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Co ent. l <br /> certify that the waste minimization statement identlfiad in 40 CFR 262.27(a)(I I am a large quantity genera (b)(if I m a sm nerator <br /> rots PdntedRyped ure Name gnat ' <br /> c"-7 _ Month Day Year <br /> J115.Imema ional Ship <br /> F ❑Import to U.S. ❑Export from U.S. I lort of entrylexit: <br /> ?I Transporter signature(for exports only): to leaving U.S.: <br /> W 17.Tr8nsporter Acknowledgment of Receipt of Materials <br /> r nspo t PdntedrrVW Name- ignature Month Day Year <br /> Pri� ams I <br /> Mo nyr �Dayy <br /> yei <br /> r 1 <br /> 18.Discrepancy E/j <br /> 18a.Discrepancy Indication Space ❑Quantity ❑Type ❑Resi e <br /> ❑Partial Rejection El Full Rejection <br /> Manifest Iference Number: <br /> 18b,Altemate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> if Facility's Phone: <br /> W 18c.Sgnaturo ofAltemate Facility(or Generator) <br /> Q MonthDay Year <br /> z <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recyding s ems) <br /> z. H141 3. <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> PrinfedRyped Name Signature Month Day Year <br /> 17� 45L, G <br /> EPA Form 8700 22 Rev.12.17)Previous editions are obsolete. DESIGNATED F LI (PA'S a MANIFEST SYS M <br /> �0d.2)14941/156023 <br />