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99 SHIP# 221,280786 <br /> Please print of We.(Form de5lgnad for use on elite(12.01chF ty .) 73 Q S B 6 2 d d 3 3 K S <br /> par 1i111Ft77t1!kiA7ARfl[WS 1 Genera«b NcsnJ<r 1 a. FormApp o*d.OMB No,2050-0039 <br /> WASTE MAMFEST CADW.48;331 R T <br /> -I00862663 SKS <br /> CaI.—Trarrs Shop W— Lodi C'ws Cenerawssileaddroser't Werert In ma toadtress) <br /> 845 E Bine 3t <br /> LE�i?f CA 952-40-31$8 <br /> Ganerator'a Phone: 205—,�33—b5�3 <br /> 6.T <br /> 'i FETY KLF SYSTEMS, ING. U.5. PA R7 NumEer <br /> T.T 2CernPuryName TXWftt06I <br /> U.5 EPAfbNu,npdr <br /> t§.Da:gnated Fac3ily Name and SBe Address <br /> SAFETY--KLEEN OF CALTrzORNIA, INC« u.s-EPA6)Nunber <br /> 6880 SMITH AVE. <br /> aciNys <br /> F 510-795-444 � CA 945EIa <br /> Phone: <br /> UCAU980887418 <br /> 9n.11.s.boi oeerga«fndudnp Peva y�1e Rasa Gaae,b Num, <br /> NH P >A 4Cdanyi} TO Mailer-, 17.ro of <br /> i2.IJn6 i3.Waste Codes <br /> ETlf <br /> 1' <br /> NON <br /> EN FtgZA IDOUS WASTE,LIQUIF: No. Type � + vrt^�d <br /> GLYCOL SOLUTION (LESS THAN Sit%) i r C <br /> 4. <br /> . 9 kK4ua6otts andpddBerlg Mtannatioe <br /> TMEVS 72504742 0147558 22171 CSE:1 <br /> 24 HR Eh RGFI Y 01-800-466-1760 {S}{ ! TFI1 <br /> aa—LIGIIGEflERATOMOMROR'8�ELI „ t�'" T= �' <br /> EarfiD 5m:1 he'aby 6-dam Iral the mntBnlg ori omen!are <br /> Waked and fabeled'�ac�dedarq are in alf ags5e+�In ptc}+or randVGm for cof* h*end a.r tety;eII ad abore by the PmPW*ri 0 n�»�and are tlaeaified.draw <br /> E�a�r,!oetilytat dreavdamsofthismna+l7+a�nntmfk,mtothetermsoff1. a jtoapplicableatematioralanonalmalgwemmanufogutstlons.IFaspn4sttipmantandtemdteP'hnaq <br /> I ore*sat fie waste nom;statement irkntrF.ed n!p CFR 262.27(al q I ama 61i E sI gerc eWtt x ci Consent. <br /> 9ua^h3'9enr+alnq a{tr}{If! a ay ga'>draWrJ tma. <br /> (gjIII Day year <br /> -+ 6.lntanaSutral stwrnefsts Y Rr <br /> 1 ,`7 t4f <br /> ❑YapdttteLLS. ❑E,padkm us. <br /> 7ransPphe+si9ns4re(3reaparis a'tN1� <br /> � 1T.Transar�r�tdReocfptdAlarerols Dale leatirg D.&: <br /> or TranI Name <br /> V) hlorm aw Y" <br /> raruPoro°r yped Name 't , <br /> `matte <br /> morm Day 1&ar <br /> 16 It <br /> ?Bi{aamspamy Hca m Space 4ua-"4 �T ❑Resdue t—� <br /> L_.!Partial Rejectdn ❑FA p <br /> 78b.AIlerrraBa Far,�igt#o€Ga.`mralat Mandest Referenos N,Jnper: - <br /> us.t�;fl ral�res <br /> F-AV.Ph.- <br /> � 1 maltenrataFaCRby#orsanetaa�r} <br /> hion!h Day 19mr <br /> 19.Ra-dour Waala Recon Mm&g n"Mellmd Codes p.m.orales for tulmdous waste treatment.dispo9al,and roc <br /> 4 ` ydarg rsl <br /> 20 De0gnas3d faI Oianer <br /> None .Gertyl®tIn of WWW df h82&ftm mewials cmremo by bre rnarrlestesmvasnMd' mi8a <br /> 3-cc& !DRY <br /> G <br /> EPA Fotm8700.22 iRev.3-05}P tions are 00 ( f <br /> 1}651 f 15{ 130 DIIIs p FACILITY f0 f3ESTINkTfC3Es€STkTE(IF FiEC3lltA L?) <br />