COMPLIANCE INFO_2021 - Laserfiche WebLink

Home Browse Search

SSL SK SHIP# 229096519 1 sill Please print or type. 0071s1326.9 11 B b Form ApprovedOM No,2050 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Erne en Re nse one 4.Atanrfest Trackin8 Npmber WASTE MANIFEST CAT000613968 1 1- 0 -48-1760 7 181326 SKS 5.Generators Name and Mailing Address Generator's Site Address(if different than mating address) n SAFETY—KLEEN SYSTEMS, INC. SAFETY—KLEEN SYSTEMS, INC. PO BOX 555 5050 SALIDA BLVD SALIDA CA 95368 Generators Phone: 209-545-1011 SALIDA CA 95368 s.TWYAs W SYSTEMS INC U.S.EPA ID Number TXR000081205 7.Transporter 2 Company Name U.S.EPA ID Number CLEAN HARBORS ENV SVC INC, IMAD039322250 8.Designated Facility Name and Site Address SAFETY—KLEEN SYSTEMS, INC. U.S.EPA ID Number 6000 88TH STREET Faclliiy's Phone: SACRAMENTO , CA 95828 916-386-4913 CA0000084517 ga� 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, o.Containers HM and Packing Group IN any)) 11.Total 12.Unit 13.Wash,Codes o. Type Quantity Wt.Nol. W 1`NDiY— O W � 2. NON--RCRA HAZARDOUS WASTE LIQUID DM 6 134 ' (AQUEOUS PARTS WASHER SOLUTION) i 4. 14.Special Handling Instructions and Additional Information TSD:SCA SAL CSG: , 24H EMERGENCY#800-468-1760—CH/SK/TFI—Contract retained by generator confers agency authcrri y an initial transporter to add or sub5titutp additional transpnrtprs an s behalf- 15. GENERATOR'SIOFFEAOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, marked and labeledlplacarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations.If export shipment and I am the Primary Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. I certify that the waste minimization statemerd identified in 40 CFR 262,27(a)(it I am a large quantity generator}or(b) 'I m a smallqjntky gq05,0V g ,0is true. Genera sl rot s Pr n dli ed Name Signature Month Dacey" Year J 16.International Shipments J ❑Import to U.S. ❑Export from U.S. o of entrylexit: Transporter signature(for exports only): ate leaving U.S. W 17.TransporterAcknowedgmentofReceipt dals ff Transporter 1 Printed[TV erne Signature Month Day Year a_ (A --- '4�2 __ Transporter 2 P iedfTy me Signature Month Day Ybar 18.Discrepancy l 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection _ i Bb.Alternate Facility(or Generator) Manifest 2jfeTenc8 Number: U.S.EPA ID Number J_ V Facil• s Phone: W t8c,3griature of Alternate Facility(or Generator) Month Day Year Q z 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposai,and recycling systems) 0 1. z. H141 3. 4. 20.Designated F.dlky Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as n in Item 16e PdntWyped Njqq f ,e1} �f 2y EPA Form 8700- (Rev,12-' Previous editfons are obsolete. 1 -14 )14941/1560233 DE5IGNATE AC Y TO EPA's e-MANIFEST SYS EM