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v. nmwyviw i ♦,mupmiy name U.S. EPA ID Number <br /> `3AEF_ TY—KLEEN SY, TI MS INC f ' RIZb �h31 ;' t5 <br /> 7. Transporter 2 Company Name U.S. EPA ID Number <br /> CLEAN HARBORS ENVIdRONMENTAIL SVC TNC . MAI��'tw9.',r:t ' <br /> 8. Designated Facility Name and Site Address SAEET V ` KLI<EN SYSTEMS , INC . U.S. EPA ID Number <br /> 6000 88TH STREET <br /> SAs� RG�Mf;NTCI , Cil588'8 <br /> Facilitys Phone: 91 1 <br /> ga• 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, P 0, Containers 11 . Total 12, Unit 13. Waste Codes <br /> HM and Packing Group (if any)) <br /> o. Type Quantity Wt,Noi. <br /> 1 . <br /> O am �.t nr in nnnrzr`_ 1.., <br /> .� � rY7TtcicTO" Ysrct"rTCCI <br /> W i ( <br /> LU 2, NON-- RCRA HAZAR301LIS WASTE LIQUID DM i • 34 I <br /> . ADUEOUS PARTS WASHER SO UTION ) —!—" <br /> •rr I <br /> 3. <br /> 4. <br /> 14. Special Handling Instructions and Additional Information <br /> TSD : SCO SAL CSt; <br /> 24H EMERGENCY#800 468- 1760 CH / SK / TFI --L: antrart retained by generator canfer �, a ency a. o- r. thori y <br /> ini * iar. a i S <br /> 15. GENERATOR'SI( FFEROR'S CE FICATION: i hereby declare that the contents of this consignment are fully and tely described above by the proper shippin name, and are classified, packaged, <br /> marked and labeledlplacarded, and are in all respects in proper condition for transport according to applicable intematioru and national governmental regulations. If export shipment and I am the Primary <br /> Exporter, I certify that the contents of this consignment conform to the terns of the attached EPA Acknowledgment of Con ent. <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a) (if I am a large quantity generator) or (bJW In a small quantity generator) is true. <br /> Trrors Pon ay ear Zo <br /> F�A <br /> Ile <br /> =J I 16. lnte ation Shipments <br /> y— �_ ❑ import to U.S. ❑ Export from U.S. golaivnUxa: <br /> Tra iter signature fore ons on]4: <br /> 17. Transporter Acknowledgment of Receipt of Materials <br /> Tr spo er 1 Printedli Name Signature h Day Year <br /> CL <br /> Transpoerg Pri ypedSignature Month Day 75ar <br /> 18. Discrepancy <br /> 18a. Discrepancy Indication Space Quantity ❑ Type ❑ Resio lue ❑ Partial Rejectionj <br /> ❑ Full Rejection <br /> Manifest F eference Number: <br /> 18b, Alternate Facility (or Generator) U.S. EPA ID Number <br /> J_ <br /> V <br /> Q <br /> �- <br /> FacilitYsPhone: <br /> W <br /> 18c. Signature of Alternate Facility (or Generator) Month Day Year <br /> a <br /> Z <br /> 19. Hazardous Waste Report Management Method Codes (i.e. , cafes for hazardous waste treatment, disposal, and recycling systems) <br /> UJ <br /> 2. H141 34 F'}# 41+ 4 <br /> Ca' <br /> 20, Designated Facility Owner or Operator: Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> P ' d Name Sign M th Day Year <br /> EPA Form 87 22 {Re 5) Previous editions are obsolete. DESI NATED FACILITY TO DESTINATION STATE (IF REQUIRED) <br />