|
SaL .5k 8141P4 228448$47
<br /> Please prim type. Form Approved.OMB No.2050-0039
<br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Pag 1 of E e fse- a 14.Manifest TrackingNumber
<br /> WASTE MANIFEST C:ARCa0009 i di ' �11 , [ '�� �'o 007070157 SKS
<br /> 'Generalor's Name and Mailing Address Generalor's,SI16Address(It different than mailing address)
<br /> Fsc-.81 t).• PremaeV3.' ndy Inc.
<br /> CSCALt]N ` CA"751W0,0000
<br /> Genera6,'s Phbnd:
<br /> I.
<br /> 01fl'e�.Yo�r�r��V.aystos INC U.S.EPAIDNumber UP,000081205'
<br /> Zi irensporler Comp ny Name U.9 A ID Number
<br /> 8:Designated FacllilyNamgand SiteAddtess SAFETY—KLEEN VVEMS, INC. U.S.EPAIDNumber
<br /> 6000 BETH STREET--
<br /> SACRAMENTO a .CA 01552$
<br /> CA0000084S17
<br /> 9a gb.U.S.b0 esc PBon(Including Prbpar Shipping Name,Hazard C4a$S,.ID Number, 10,Containers 1 Owl 12.Unit 13.We Codes
<br /> HM :and Packing Group(if any)_,:::Y
<br /> xy •. No. Type Qu9nUry. WLNoI. '
<br /> I-INUN�-RCRA. HA;ZORDOUS WASTE, LIQl3�t�
<br /> o (A(lUE0liS PARTS WASHER SIBLUTION)
<br /> LUSwh
<br /> I7 U V b
<br /> 3. J U f ( r. I �J
<br /> 4.
<br /> Special HaPd[IrIg InstrubtidnSand AdtliUbnal lnforme4on TSD:S •,.• '1130037441 ES12014 MU 1,9"n. .coe Al.
<br /> 4H 0#906t4010.04468'..1740-CH�'S4C TFZwCIxrlGra ri �a n�ti �y generai:air eanfers a -ncy autliar4u ` '
<br /> on, 101' t,.41 'toaus t)rter to adO or -"Ltitute addx'tiniiial transporters On ciengr4t6t"s behalf..
<br /> 15. GFNERATOR'SIOFFERQR'S,CERTIFICATION: I hereby declare that the bontents gQhls consigamenl are fully and accurately described above by lhe.propershippft name,ard:are plasslRed,packaged;.
<br /> marked and Iabaledlpligarded,and are'in all respegl6In proper condillon for lfanspbrt according to applicaple Intomal1pnal and nallooal governmental regutallops,If export shipment-and I arh the Primary
<br /> Exportsrj,,ceriffy lgat the contanis V this consignment conform to the teOns of the attached f PAAcknoWidgmegl of Consent.
<br /> I certify tlioCthb waste mlhImtz 161 staterdent Identified In 40 CFR 262.27(a)(if I am a largo quantity genera or(b)(ill am a small quantity generator)Is True,
<br /> GeneratorslOfterpi Printed/Ty Qd Ne a' Signal Month Day Year
<br /> :�,;� 1',.In(erri a e)Shiptn�nt5 k �.:'� Y R •i• i ;.Y'n - e e ,:
<br /> 11,,� v thiport to US. • :0 ik�rl Fran U Poltcl enhyla7dt �r
<br /> 9lpn0,Wre(for egpA Dn(yi.' '' bate lesving U5,
<br /> 95; {apspo[te�AcFCnowlddgiiipgtof,R✓idelpfofMAlerialg' r ALI
<br /> c `
<br /> Ira rler Prix yp d a xd { 51 re Month -.,'D
<br /> • a ''YaQr
<br /> ;z er 2 PrinteriRypod aTo - : ` Mpnl�: Cjay
<br /> •� ��•y',��:�vt Nvj�' (fes ^'ll •
<br /> 18.Pisdrepandy nn
<br /> 180,biscrepanajr 4ntllcetlor� pace '�;©� ; D.Realdue ❑Partial F1eJodtldn ❑Full RaJection,'
<br /> �l�:' •••p,,,,;r'_y..:ffir 4xu.�.«.:r�:y-•:t�ra,:.. ..+ w-• •w, ',+, .Y.a!' NS '•.,r •ies"ren dllumbeerv:1w rr'.tart 'r• '�.,,. .ode:1a._.' .�;-+'„ .ti,,
<br /> 18b.Altemale Faciiity"(or Genera Cor)' ::,: U.S,EPA ID.Numbar
<br /> T!,16192. ture of/uteinite Facflfty(or'•rj�retatof). Monih Day Year
<br /> n.Hazrdoue:Wgs(e Report Mei{aoomenl Method Codes(Le.,codes for hezerdoildv/e8le1realment,dlsp6gal erld teryChnb gyslems)'
<br /> 4V�9•d'W•'kp}p,y�y�rtP^',+'Wf'Rgd Ir•� 1i'tl1W( Wf/trI.M14 /•Y \d �i',•'' � A, - �.• � f1
<br /> 20.Oeslg6ated FedllllybO nee or Operator,CDOcatlon of rooelptof hbzerdous materials govordd by Ilia mahifnsi okcept as n od In Ilam 18i
<br /> PrlpledrType ,ame _�} Signabrre on ey er
<br /> 0/71
<br /> 7 P,raylous edi8ons are a4solete. *,�If" 1 DESIGNATED FACILITY TO GENERA OR
<br />
|