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SSL SK SHIP# 2221771 111111N1111111111111111111111 <br /> 005946808SKS <br /> Pease <br /> {ring or type(Farm d nod lur use on elite(12•pllchl Npewrllar.) Form 7 rcmA OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1 Genere o ID Nomber CAT000613%8 2.Paga11 of f!!BWW Iwo <.h1;"ft,tT"9Q Hum <br /> WASTE MANIFEST 005 4 6808 SKS <br /> 5 Gwre+alaro Name ati!xlalhp Address Go orabrs SIw AAdaee id avkry 4 than maths mddm%) <br /> SAFETY-gL 1 SYSTEMS, INC. SAFETY-KLEEN SYSTEMS, INC. <br /> PO BOX 555 5050 SALIDA BLVD <br /> SALIDA CA 95368 <br /> Generatofa Phone: 209-545•-1011 SALIDA CA 5536$ <br /> SYSTEMS INC Jii-EPA ID Number TXROM81M <br /> 7.irarroptyler x ryName U S-EPAID Number <br /> ClEgN HARINN'S ENVIRONMENTAL SERVICES INC MAD0393222a0 <br /> b.DeSgrieWTadllyNameandSHeAddress THERMO FLUIDS INC U.S.EPA ID Number <br /> 4P a1NIXJEFFERSON ST AZ 85043 <br /> 800-350-7565 ' AZROOON Cl <br /> Fadtity'e Phone: <br /> ga91b US DOT Description(including Proper SHpping Name,Hazard Class,ID Number, 10 Containers 11.Tolal 12.Unit 13.Waste Codes <br /> end packing cking C-up(iany)) No Tyne Quantity WLIVol. <br /> 1 tlNF HAZARDOUS WASTE SOLID DM �y/� P <br /> (DRA223 + <br /> [DRiIINEI)fUNT}RAINED USED 62L FILTER5) <br /> w <br /> z <br /> w <br /> ra <br /> 3. <br /> a <br /> ti.SpeciRl I?AWHrV 4iuhudlomand Add oml Inbm *m TSD:TPR SAL ( ' <br /> 24 HR EMERGENCY IF!-80�-4fi9-1760 (SK / TFI) �� <br /> AUTH AS a <br /> 13Y WN M RETAIN LICENSED SLIB CARRIEM <br /> 15. GENERATOWSCI FFRM9 CERTiF1C1TIM.I hereby declare Graf the CWLIAIP of die ooneignment are fully and ouumley delated about by Oro prow supping name,aril are domifgd.Packaged, <br /> marked end lahele�,and are In all respects in proper condition for transport axordno In apPllPW Iraalnadood anal rwhond gamenmemlal mgdalbns.9export shipment and I am the Pdmary <br /> Exporter,t WIN bat ere mnloets nt ees mi*nnxxd wniotm to be terms of be attached EPA Admowledgrrrenl of Consent. <br /> I yaat Cie wash rdnnarvtlon ivalerrent Idansiled in 40 CFR 62271e}(III am Imor quantityganeraforj a(b) .e small auank romtur}Is true. <br /> Ge s Ind F4me Szpwtue Dmr Year <br /> (z �Sv_u.-L�- _ � l <br /> io.irmerne SM <br /> � ❑hripod b U.S. ❑Erporl from U.S. d aA <br /> = TlmrspoderWounve(broppwsody) US-: <br /> aC 17.TnmapmtwAdcmeledgmentofReoetptorMaterials <br /> 'ren PnaloWTyilod 5lgndure 7 <br /> er <br /> TmnepaNar'r Nan a Sig o ue Mpnb Day Year <br /> o >� a <br /> 19.Di5Crepang . <br /> 10a Discrepancy Indication Space ❑Quen9ty ❑Type ❑Restd. ❑Parw Rejection ❑Ful Refection <br /> MtanitaFt Refarerrce Imber. , <br /> W Alemoa Faaxry(or Oorre xw) US.EPAID Number <br /> V <br /> fatakyY Plwne. <br /> `W w Surer of Aitembb ForAq(or Gomranrl MMh IhY Year <br /> 2 <br /> h19.Hezardow Waste Report Wnegement Meew Codes 0 e.,codes for hazardous waste treatment,dlsposA and mcydktg syskms) <br /> � 1 :5 2 3. 4- <br /> 20.Dn4ftoled Fedlllr Owa�or br:QYA*Liani recdµof haavckm malonala covered by be morAIA aniepl as Med int <br /> Rft WTyl*Namewc4.� / B� I 7 <br /> Ig"w M Day Year <br /> 305) <br /> EPA l 7)_ 22t$72 ev. FrB33 edlilum am obGam DESI ATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />