COMPLIANCE INFO_2021 - Laserfiche WebLink

Home Browse Search

SSL SK SHIP# 227097409 11111111 I�III III�IIIIIII II IIII 111111111 • 0066575043 K5 Please print or type. Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number TX RO@0081205 2.Page11 of 3.fm r R ogse Ih°f D0 4.Manifest Tracking Number WASTE MANIFEST 006687504 SKS 5.Generator's Name and Mallin Address Generator's Site Address if different than mailin address) SAFETY-KLEENq SYSTEMS, INC. SAFETY- LEEN SYSTMS, INC. PO BOX 555 5050 SALIDA BLVD SALIDA CA 95368 Generators Phone: 209-545-1011 SAL T DA CA 915 368 s.Trp f9o�> SYSTEMS INC U.S.EPA ID Number TX 800008120' 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address SAFETY-KLEEN OF CALIFORNIA U.S.EPA ID Number 6880 SMITH AVE. NEWARK , CA 9456>h CAD9808874' 510-795-4400 .P Facility's Phone: 9a. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12,Unit HM and Packing Group(if any)) No. Type Quantity Wt.Nol. 13.Waste Codes 1. NON-RCRA HAZARDOUS WASTE, LIQUID TT S 2121 o (USED OIL) i S37 z 2. W 3. 4. 14.Special Handling Instructions and Additional Information TSI)0 EVG SAL. F C. ; 24H EMERGENCY#800-468-1760-CH/SK/TFI-Contract retained by generator confers agency authori y on initial transporter to add or substitute additional transporters ongenerator' s behalf. 15. GENERATOR'SIOFFEROR'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 labeled/placarded,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 EPAAcknowledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a small quantity generator)is erors Printed/Typed Nameature Month Day Year 0001,,-, 7 ►Z r .J J79.Tnternational Shi ments � ❑Import to U.S. ❑Export from U.S. Port of entry/exit: ? Transporter signature(for exports only): Date leaving U.S.: cc 17.Transporter Acknowledgment of Receipt of Materials W T sporte 1 Printedfiyped Name-,) gnature �� Month Day Year ciz CL m , 1 I rz c Z TrMMMT9JpZ5rTer 2 Printed Typed Name Month Day Year H 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantityyp j j ❑T e Residue Partial Rejection Full Rejection Manifest Reference Number: 181b.Alternate Facility(or Generator) U.S.EPA ID Number J U LL Facility's Phone: w 18c.Signature of Alternate Facility(or Generator) Month Day Year Q Z y19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) LLI 1. 0q2. 3. 4. 20.Designated Facility bwner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Pdnted/Typed Name Signature Month Day Year i EPA For QO2j�``� 2- Previous a itions are obsolete. D S ED FACILITY TO EPA's e-MANIFEST SYSTEIy OR 144 �1IY/T ()0WA04SKS