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Please Print or iype.,.(Form designed for use c ell
<br /> l3'ORM WAWD'OUS i-GeADM(OrlForm Approved,ONIB No,2050-0039
<br /> 'OR 2�PagDlof Emergency3. Resifoil�.0—Ph7�,,----T4—M�nifest Tracking Number
<br /> ASTE MANIFEST 406-1760 1
<br /> 5,Gonoralor's Name and Mulling Address r5 A9, S�KS
<br /> Goneralo ailing address)
<br /> i�t 4 2 7)")D IS t
<br /> 3,��Jc - -Dao
<br /> Genera o one: CA 458 1 3,�*;,�)1 @ ply
<br /> I Company, -,�
<br /> 6.Transporter -q Name
<br /> SAF7ETY-KLEEN 53Y8TPqS U
<br /> INC
<br /> 7-Transporter 2 Company Nome T X 900-008
<br /> U.S.EPA 10 Number
<br /> ERTAI- qef�#)I flA 1w
<br /> 8,Designated Facility Name and Site Address
<br /> EAN HARBORS Simi itigit U.S,EPA ID Number
<br /> 21 ROAD
<br /> Facility's Phone:
<br /> ga, 9b,U.S,DOT
<br /> Description(including Prop 3r shipping Name,Hazard Class,ID Number,
<br /> HM and Packing Group(if any)) to.containers
<br /> 11.Total 12,Unit
<br /> 13,livasia codesi
<br /> No, Type Quantify WLIVOI.
<br /> 0 W-Ar—. x1f:1 -'RA I'VI ZARWU�3 WAS11. -SCL,109,
<br /> PETROU11-K )-Iv,DR50ci1'4rQ,T
<br /> W Uj 7—
<br /> Can
<br /> 4.
<br /> 14.Spacial Handling Insiruclions and Addiffonalink
<br /> fmat
<br /> Tn TM 194 73,324&17
<br /> CI 13793 CM I
<br /> TFI)
<br /> 111rd Air I'.I IN! I J`�1 1:I j
<br /> markQd and labeledlplacarded,and are in all re pectis in proper condi8on fortransporkaccordiny PlIng name,and are dassilled,packaged,
<br /> Exparier,i cart fy That the contents of 1hl�s�onsi nme�t conform to Ihp temrs of the to applicable Inlohlallonaland national governmental regulations,Ifexporl shipment and I am the Primary
<br /> Acknowledgment of Consent,
<br /> ,la rtify That the waste minimizaifon statement lenir8 d irr40 CFR 282,27 a if 1 am a Tor a ua Itily gonerao.or(b)(Jfl
<br /> quandY9'no tor)14(rue.
<br /> '7"Y "
<br /> fear
<br /> M Intemallons shipments
<br /> Export from U.S. Por(or.erilrylexil:
<br /> Transporter signature tfnr Data leaving U.S.:
<br /> 17.TransporlerAcknowledgment of Raceflotol.,.........
<br /> Tran po not dflyped Name
<br /> 0
<br /> Slgnatups
<br /> Month Day Year
<br /> z Trans ad Prif �e I V r,
<br /> odMFT ed Name I/Z/
<br /> "Jgnalurv/
<br /> Mtmlh Day Year
<br /> F-
<br /> 18,Discrepancy
<br /> 18a.Discrepancy Indication Space
<br /> Ej Quantit Type
<br /> Residue Flp.ditolRojectle, ❑
<br /> Full Rejection
<br /> Ob.AIIemT1WF—.d-11N ..........Manifest Reference Number.,
<br /> U.S.EPA 10 Number
<br /> U<- Facility's Phone:
<br /> UJ 18c.Sign��Awof Alternate�Fcllity(or
<br /> MON—DayYba,
<br /> z
<br /> 0
<br /> 19,Hazgidous Waste Report Management Molh
<br /> n ad Cod (l, .,codas for hazardous waste treatment,disposal,and recycling systems)
<br /> 3.
<br /> 4.
<br /> c lily O%'YSV-oMporalor:Carlilicallon Voc I el
<br /> "manifest ex apt as nct ipd(emfl8a
<br /> Prince I I Vpod N me
<br /> 7� Day Year
<br /> L-
<br /> Ll
<br /> EPA Form 8700-22(Rev 3-05) Previous editions are c bselete.
<br /> DESIGNATED FACILITY TO GENERATOR
<br /> 4-�3 6
<br />
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