Laserfiche WebLink
FSL SK SHIP# 226584542. 1111111111111111111111111111111111111 <br /> 0 0 6 7 7 7 8 3 5 S K S <br /> Please print or type. Form Approved.OMB No,2050-0039 <br /> UNIFORM HAZARDOUS 1 Generator ID Number -,.. n t r i7, ;:, 2.Pa of 3. me R 1 4.ManifestTracking Number <br /> WASTE MANIFEST <br /> } - - 006717838 SKS <br /> 5.Generators Name and Maitin Address Generators Site Address(if different than mailing address) <br /> SAFETY-KLEEI� SYSTEMS, INC. SAFETY-KLElN SYSTEMS, INC. <br /> PO BOX 55 5050 SALIDA BLVD <br /> SALIDA CA 95368 <br /> Generators Phone: 209-545-11011 SALIDA CA 95368 <br /> s.Tr�psr�adar.fi�rrtWlrlv-Natoe SYSTEMS INC U.S.EPA 10 Number TX R0910081.205 <br /> 7.Tranlsipp�rletr 2 Comhp4aln��tNa�m^e7 U.S.EPA ED Number <br /> CLEAN HARBORS ENVIRONMENTAL. SVC INC. MAD039322250 <br /> 6,Designated Fablity Name and Site Address THERMO FLUIDS INC U.S.EPA ID Number <br /> 12533 SE CARPENTER DR <br /> CL..ACY.AMAS , OR 97015--8988503-788-4615 013010100@25197Facility's Phone: <br /> ga 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit <br /> HM and Packing Group(if any)) No. Type Quantity WL(vol. 13.Waste Godes <br /> 1. NON-RCRA HAZARDOUS WASTE SOLID <br /> o (DRAINED/UNDRAINED USED bIL FILTERS) t o <br /> a 1 <br /> z 2. <br /> w <br /> f7 <br /> 3. <br /> 4, <br /> 14 Special Handfing Instructions and Additional Information TSD:TPO SAL CSG- <br /> 24H EMERGENCY#800-468-1760—CH/SK/TFI—Contract retained by ganeratar �anfers a ency eat: <br /> on initial transporter to add or substitute additional torn. ar erg un anerat©r'. 6eh <br /> 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, <br /> marked and labeledlplacarded,and are in all respects in proper condition for transport according to applicable intemaoonal and national governmental regulations.If export shipment and I am the Primary <br /> Exporter.I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. <br /> certify that the waste minimi statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b m a small quantity generator)is true, <br /> Citinjillstor'slOffem tedfTyped Nf ame Signature Month Day Year <br /> W`- DSI(QJ <br /> _j 1 16. temati I Shipments <br /> F— ❑Import to U.S. ElExportfrom U.S. Po (entrylexit <br /> ? ns is <br /> signature(for exports only): a leaving U.S.'. <br /> CC 17.Transporter Acknowledgment of Receipt of Materials <br /> K n iter 1 Print Name Signature Month Da Year <br /> a jauj <br /> Zcans) ergnted(Typ me Signature Month Day Year <br /> I &>i <br /> [$ <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication space ❑Quantity ❑Type ❑Residue ❑Partial Rejection <br /> Full Rejection <br /> Manifest Reference Number: <br /> I8b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> LL Facility's Phone: <br /> LJ 1&.Signature of Alternate Facility for Generator) Month Day Year <br /> Q <br /> Z <br /> N19.Hazardous Waste Report Management Method Codes(Le.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 1. 0141 <br /> 2 3. 4, <br /> 20.Designated Facility Owner or Operator.Certi£tcation of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Pnirtedayped Name Signature Month Day Year <br /> Tom,, S N I 1 10 7-3 1/-? <br /> EP F ¢0-/0I? <br /> v 1 P viouseditions a obsolete. DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM <br /> )° <br /> � „ <br /> OR14472_WT_006777838SKS 12 <br />