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SSL SK SFIIPII �'P9�6 - V ` " f r� 111111�I�I � ��I�� <br /> Please print or N ned for use on elite(12-pitch) ter,J 90, <br /> 0 0 O 6 S 2 0 2 0 2 3 K 3 <br /> Form Approved.OMB No,2050-0039 <br /> UNIFORM HAZARDOUS 1 I trera00lor Hum 7T W R1660"12 2,Pp�p�t 4f .3.1 ,r � s' �@ ` o o s ` o o SKS <br /> WASTE MANIFEST (L't�Q(60 Z{ y ]T o+� <br /> a Genefatcr's Name end Matting Amms ' `�a G�Ws S+WAddreas fig dfllerant then mai N adtfrm) C — <br /> C� r <br /> ] a l dr(-V l I/t R!r <br /> Orators Ptta>a. <br /> Tr9MYrrgr LM SYSTEMS INC u-S.EPA ID tktmber <br /> �L TXR@@@081205 <br /> 7 Transputer 2 Company Name U.S.EPA tbNumbar <br /> CLEAN HARBORS ENVIRONMENTAL SVC INC. MAD@3932225@ <br /> 8 Designated Fnralily Name and Site Address <br /> THERM FLUIDS INC US.EPA ID Number <br /> 12533 BE CARPENTER DR <br /> Farrell'S Phone: CLACKAMR5 , OR 97015-8988 503-788-461E OROOSM25197 <br /> go, 9b,U S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Conlairrers <br /> HM and PgackinGroup(d any)) 11.Total 12.Unit 13.Waste Codes <br /> No. fTypa Quantity WLNaI <br /> o NUN-RCRA HAZARDOUS WASTE SOLID DM P 223 <br /> (DRAINED/UNDRAINED USED biL FILTERS) 1 <br /> X 2 <br /> W <br /> c� <br /> 3 <br /> I <br /> 4 <br /> I <br /> IJ Speoai Handtrrg Instructions and Addiliornal Information TSD:TPC SAL CSG: <br /> l!�1 '4 HR EI4ERSENCY #1-800-468-1760 (CH / SK / TF I) � <br /> � 0 D <br /> 4 <br /> 15 4ENERATOR'SlOFFEROR'S CERTIFICATION. t rleraby dware that the contents of this Wnsignn>anl ere fully and avAdately descrbed above by the proper shipping name,and are classified,packaged, <br /> marked and labeled/placarded,and are in all raspWs In wum cnr¢dhon Int transp n according to apps abre irrlemakneiand national govemmentai regulations.It export shipment and I am the Primary <br /> Exporter I nsrllfy that the contents of this oNnstgnmenl conform to the lemts of*4 atlantad EPA A6ndQNedgmenr of Currsemd. <br /> i certify that the waste minimization statement identified in 40 CFR 262 27(a)(if I am a large quantity generator)or(b)(It am a small quantty ganeralerl is true. <br /> Ugnentos sl6tnrurs Fnniodlfyped Name � Signature --. - Montt 0,4 Yeat <br /> 16 [ntarr almal Shipments <br /> i ElImport to U S. C1 Export from U-S. Port of entry/exit: <br /> — Transporter srgnafure tlor exporrs ontyf; Date isavrtug U 5 - <br /> 17 Transporter Acknowledgment of Receipt of Materials <br /> Tr r 1 Pmtlwlrf Onto Sbgrtalure Matt( Do Yeas <br /> Trans er Hied y rrm signalore Month Oay Year <br /> c s <br /> 6 Disuepaircy <br /> i ' <br /> 1Ra.Oiscrepancy;ndication Space LJ Quantity TypeLi-1 Residua ff�� <br /> Portia]Rejection Ll Full Reject. <br /> Mamregt Reference Nuovioal. <br /> IZ 18b Alternate Facdply top Generator) U.S EPA ID Number <br /> n <br /> U <br /> 1QL. FAcllay'F Phone <br /> Ilk Month (bay Year <br /> a <br /> z <br /> 19 Hazardous'Nasle Report <br /> � po Management Method Codes¢e codes for hazardous waste treatment,drspNaal,and recycling systems) <br /> Q 2 3. 4 <br /> Q& <br /> 7asignateo Rdcruly Owner or Operator Certification of receipt of hazardous malenals covered by the manifest except as noted In Ilam 16a <br /> r'r rHr.l ype f Nanuf S gnaturo rton a Year <br /> EPA Form 8700-22(Rev 3.05) Pre us oditions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REOURED) <br /> 1)78'7R67i 15603 <br />