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SHL SK SHIP# 231331293 <br />liiiiiiiiiiiiiiimiiiiilloilillilI <br />o or 5.°mld%3M%2050a. <br />Pi88SB <br />print or type. <br />UNIFORM HAZARDOUS <br />1. Generator ID Numb& <br />TXR000081i'05 <br />2. Page 1 of <br />1 <br />3. R P <br />4. Manifest Tracking Number �� <br />525 <br />WASTE MANIFEST <br />5. Generator's Name and Mailing Address Generators site Address ('ddifferent than mailing address) <br />SAFETY-KLEEN SYSTEMS,INC. SAFETY-KLEEN SYSTEMSy INC. <br />PO BOX 555 5050 SALIDA BLVD <br />CA '35368 <br />SALIDA SALIDA CA 95368 <br />�-09-545'--1011 <br />Generator's Phone: <br />�� U.S. EPA iD Number T X 8000081 205 <br />"Tr'Rrl! nrpany,�t� SYSTEMS INC <br />bnsporter i2 <br />7. TraCCo�mpp�aln�ytName U.S. EPA to Number <br />MAD0393i�:?250 <br />CLEAN HARBORS ENV SVC. INC. <br />8. Designated Facility Name and Site Address SAFETY--KLEEN SYSTEMS, INC, U.S. EPA ID Number <br />-6000 88TH STREET <br />SACRAMENTO , CA 95828 CA0000084517 <br />916-3864913 <br />Facilh Ps Plane: <br />ga. 9b. U.S. DOT Desoripfbn (including Proper Shipping Name, Hazard Class, ID Number, 10. Containers 11. Total 12, Unit 13. Waste Codes <br />HM and Packing Group (if any)) No. Type Quantity WINol. <br />c>! <br />a <br />y <br />z <br />2. NON-RCRA HAZARDOUS WASTE LIQUID <br />DM <br />G <br />134 <br />(AQUEOUS PARTS WASHER 90 UTIGN) <br />c <br />BF <br />4. <br />14. special Handling instructions and Additional Infomralan TSD : SCA SAL. CSG <br />24H EMERSENCY#800-•468--1760--CH/SK/TFI--Contract retained by generator confers agency authori <br />on initial transporter..- to add or substitute addttional trans orte s on--Qenerator's behalf. <br />CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately desa above by the proper shipping name, and are classified, packaged, <br />15. GENERATOWSIOFFEROR'S <br />marked and tebeledlpiacarded, and are in all respects in proper condition for transport according to applicable intemabonal and national governmental regulations. If export shipment and I ant the Primary <br />Exporter, I certify that Bre contents of this consigrunerd oonform to the terms of the attached EPAAdmowledgmant of Consent, <br />I certify that the waste minimization statement identified in 40 CFR 26227(a) (ii I am a targe quantity generator) or (b) (d I am a small quantity generator) is true. <br />[G­lorslOtfierors Pri�tedtTyped Name Signature Month Day Year <br />a a <br />tr tom; I ( <br />16. Mtemationai Shipments ❑ import to U.S. ❑ m U.S. Port of entrylexit: <br />Transporter signature (for exports only): Date leaving U.S <br />W <br />17. TransporterAdmavledgment of RecalPt of Materials <br />E2Transporter <br />1 PrinlacYTypyd Name Month Day Year <br />0 <br />CL <br />Z <br />Transporter 2 PrintedrTyped Name Signature Month Day Year <br />18. Discrepancy ' <br />18a. Discrepancy Indication Space El Quantity ElType ❑ Residue ❑ Partial R*cb. ❑ Foil Rey coat <br />Manifest Reference Number. <br />18b. Alternate Facility (or Generator) U.S. EPA ID Number <br />V <br />tQi <br />C' <br />Fac'liys Phone: <br />18c. Signature of Ahemate Facility (or Generator) Month y Year <br />Q <br />Z <br />19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) <br />a <br />1. <br />2. H14i 3 <br />r <br />20. Designated Facility Owner or operator: Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br />Prinled(Typed Name Slgnabnre Month Day Year <br />EPA <br />Form 6700.22 (Rev. 12-121 Previous -editions mD45Qk9e. _ ... - .. DESIGNATED FACILITY TO EPA's e•MANIFEST SYSTEM <br />