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SSL SK SHIP# 227161431 <br /> SSL Si'119H(R� ) <br /> +�" Form Approved.OMB No.2050-0039 <br /> ease pri'T r type.,(Form designet,'14t.won elite(12 pitch)typewriter.) 4.ManlFestTracklnU751 <br /> ber <br /> UNIFORM�H7DUS 1.Generator ID Number {��1 rr]]��)7�[t77,(0p0�y (] {{7J�� 2.Page of 3.gEmerra9�r]��Rei �(]5e Ptt p e(��r 00 <br /> ®�3 SKS <br /> (_rtYrl4.IrJVK!JttTW L`��:%9l V"�4�V'�l• `+"� <br /> WASTE _ <br /> Generator and Mailing Address Generators Slte Address(d different than mailing address) <br /> Es salon Premier Brand,; In <br /> 1905 i11cheTtry A(+e GA 95328--9601 <br /> ESa RLON <br /> GeneretotsPhone: 2"09-532"6051. <br /> U.S.EPA ID Number <br /> s.Tr ;podgy 1,�QmP?f Y �l>1? SYSTEMS INC <br /> 7,Transporter I2 Company Name U.S.EPA ID Number <br /> CLEAN HARBORS ENVIRONMENTAL SVC INC® MAIJid393�"�`aP <br /> 8,Designale.Facility Name and Site Address CLEAN HP7PORS ENVIRONMENTAL SERV IGF S, IN U.S.EPA ID Number <br /> 2247 S HL''AWAY '71 <br /> KIMBALL. , PIE 69145 NED98172351:3 <br /> ;��18•-2,�5_4Q11 c <br /> Facilitys Phone: <br /> ' 9b.U.S.DOT Description(includingProper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit <br /> 13.Waste Codes <br /> ga p p Pp g No. Type. Quantity Wt.Nol. <br /> HM and Packing-Group(if any)) <br /> )( 1' UN1992 WASTE FLAMMABLE LIQUIDS, TOXIC � DM �00 G D00 'D018 D039 <br /> o �. N O.3., . (TETRAGHLOROETHYLENE, 741 <br /> WPW <br /> HA), 3, (6.. 1), PG dII �� , t <br /> . U1 ^ . . . <br /> LU 2 ` U �� U <br /> V, <br /> f <br /> ill 141i <br /> 3. <br /> Special Handling Instructions an9dditional information TSD �:P 77808962 ES I OR 15 <br /> 1)EIIG#131• I` t'--4{'�� '�� ���r' - . <br /> 24-14 retained by :gene aQor confers '.1 envy authori :V <br /> on ?F,.;. :L trar..rrarjep 'Isco add or substitute additionAl transpgr •s a nw a .:r" s rah. 1•F_ <br /> I5: GENERATOR'S/OFFEROR'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 labeled/placarded,and are in all respects in proper condition for transport according to applicable internetibnaland national governmental regulations.If export shipment and I am the Primary.. <br /> Exporter,Icedify that the contents of this consignment conform to the terms of the attached EPA•Ackno6dg en of Consent. <br /> I certify that the waste.minimization statement identified in 40 CFR 26227(a)(If I am a large quantity generaor)or (i "am a small-quantity generator)is[me. } <br /> Generator Offerors Print dliyped Name. Signa re F Mo Day Year <br /> -j 16.intemallgr al Shipments <br /> I Import AS. ❑Export from U.S, Portof entry/exit: <br /> Z.Transporter signature(for expohts only): Date leaving U.S.: <br /> W 17.Tr ansporterAckwMedgment of Receipt of Materials <br /> ~ Tra orter.1 Printe d Nae Signator M th Da Year <br /> y . 0 l <br /> Transporter 2 Pdnied/ryp me Signature � Month Day Year <br /> 18.Discrepancy <br /> 18a ncyAnc r Indication Space D Qua t� -vI��I T Pe d EJP- 'alRej6c . E].Full Rejection ' <br /> Manifest Reference Number: a <br /> 18b.Altemate Facility(or Generator) o U.S.EPA ID Number <br /> '.Ll <br /> r. <br /> �, Faralit>tsPhone: ir <br /> yt :182.jgnZure ofAltemate Facility(or Generator) Month .Day Year. ;r <br /> azardous Waste Re rt Mana ement Method Codes a codes for haiardous'waste'trealment,.dis <br /> Po g Q:,r posal,and recycling systems) <br /> p 2. 1 13. 4. r <br /> 20.Designated Facility Owner or Operator.Certification of receipt of hazardous metedais covered by the manifest except as noted in Item!18a <br /> Printed/Typed NFrm Signe rriMonth Day Year <br /> f:,PA Fo 22 Mal <br /> us editions are obsolete. `, DESIGNATED FACILITY TO GENERA OA. ' <br />