Laserfiche WebLink
� SSL SK SNIP# 228865480 <br /> 0069539933 KS <br /> Please print or type. Farm Approved.OMB No.2050-0039 i <br /> f.Generator ID Number 2.Page of 3. me e P 4.Manifest Tracking Number <br /> WASTE MANIFEST <br /> UNIFORM HAZARDOUS CAT2�}2&13468 -���- ��- °��� 0 0 6 9 5 3 9 8 3 SKS <br /> .r <br /> 5.Generator's Name and Mailing Address Generator's Site Address if different than mailinaddress) <br /> SAFETY—KLEEN SYSTEMS, INC. SAF TY—KLEEN SYSTEMS, INC. <br /> PO BOX 555 5050 SALIDA BLVD <br /> SALIDA CA 95368 1 <br /> Generators Phone 209-5A5-'1011 SAL DA CA 95368 <br /> 6.Trarl§pode[+Comp3py��71e SYSTEMS INC U.S.EPA ID Number TX R000081 X205 <br /> bHFt Y Kl t1`� I <br /> 7,Transporter 2 Company Name U.S.EPA ID Number <br /> CLEAN HARBORS ENVIRONMENTAL SVC INC. MAD039322:50 <br /> 8.Designated Facility Name and Site Address SAFETY-KLEEN SYSTEMS, INC. LLS.EPA ID Number <br /> 6000 88TH STREET <br /> 416-385-4413 SACRAMENTO , CA .5828 CA@000284517 <br /> Facility's Phone: <br /> 9a. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 0.Containers 11.Total 12.Unit 13.Waste Codes <br /> HM and Packing Group(if any)) 40. Type Quantity Wt.Nol. <br /> Infirn <br /> ------------- <br /> z 2. NON-RCRA HAZARDOUS WASTE LIGIUID DM G 134 <br /> (AQUEOUS PARTS WASHER SOLUTION) <br /> 3. NON—RCRA HAZARDOUS WASTE LI@UID DF 8 134 <br /> (AQUEOUS PARTS WASHER SOLUTION) <br /> 4. <br /> 14.Special Handling lnstmdhons and Additional Information TSD:SCA SAL CSG: <br /> 24H EMERGENCY#802-468-1760--CH/SK/TFI-Contract retained by generator confers a envy authori y <br /> s <br /> an initial transporter to add or substitute additional tranorters on enera?o,°i behalf. <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION:I hereby declare that the contents of this consignment are fully and a*rately described above by the proper shipping name,and are classified,packaged, <br /> marked and labeledlplacarded,and are in all respects in proper condition for transport according to applicable intematio sl I and national govirfun 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 Co ri r <br /> I certhy that the waste minimization statement identi a0 GFR 211(if I am a large quantity generator)or(b)(if am a small generalor)f <br /> 10fferoi`s ed[TYPN Namenature Month Day Year <br /> Jema conal Shipme <br /> ❑Import to U.S. Export from U.S. Port of ani_ <br /> Z Transporter Signature(for exports only): Date leaving U.S.. <br /> W 17.Transporter Acknowledgment of Receiptef Materials <br /> 11— er 1 Protean nature _ Month Day Year <br /> O <br /> 94r <br /> a <br /> rter2P' a ame Sign Month Day Year <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑Quantity ❑Type ❑RekidFull Rejection <br /> ❑Partial Rejection <br /> I ❑ <br /> Manifest Reference Number; <br /> 18b Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> LL Fadlity's Phone. <br /> w 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> Q <br /> z <br /> 19.�azardous Waste Report Management Method Codes(i.e„codes for hazardous waste treatment,disposal,and recycling systems) <br /> w1' z' -141 3. H141 a. <br /> 20.Designated Facility Owner or Operator:Cartifintion of receipt of hazardous materials covered by the manifest except as of din it 18a <br /> PrintedlTy i, Signator c Mont$ Day Ygar <br /> EPA Form 87 -22 Rev 1217 Previ us diti n a e. jj[/ (/ G/ <br /> i�-t �i7't�EYtT3'2}�4 €4�1�1 i9 3)14941/1561 23 DESIGNATED�ACTO EPA's e-MANIFEST SYSTEM <br />