Laserfiche WebLink
SSL E;K SHIP# 230513094 - ,II�IIIII�I�IIII'�IIIIIIIII�IIIII�III <br /> 00738011 SS KS <br /> Please print or type. Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 12.Page 1 of 3 fTggyUyfP <br /> CARUCV�3937� $p se�tr�r�e4.Manifest Tracking Number <br /> WASTE MANIFEST 1007380115 SKS <br /> 5. .sca on nerator' Name and Mailing Address. Generator's Site Address(if different than mailing address) <br /> F'remaer Ffrands Inc. <br /> 1905 Mchenry Ave - <br /> ESCALON CA 9320-0000 <br /> Generator's Phone: <br /> i'_09--SS2--6OS1 <br /> s.T�a�s�r'�teft�Cor r eSYS1EMS INC U.S.EPAIDNumber 'i•Y:CiO00 )-3t:''(i':; <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 1lnzw <br /> 8.Designated Facility Name and Site Address SA ETY-•KLEEN SYSTEMS, INC. U.S.EPA ID Number <br /> 6000 88TH STREET <br /> SACRAMENTO CA 95828 <br /> 916•-386-4913 <br /> Facility's Phone: <br /> ga 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes <br /> HM and Packing Group(if any)) No. Type Quant, Wt.1V01. <br /> 1. NON-RCRA HAZARDOUS WASTE, LIQUID <br /> 0 (AQUEOUS FART") WASHER SOLUTION) <br /> o DM <br /> z 2. <br /> L <br /> 0 <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional Information TSD: SCA 82216794 ES12014 <br /> nn <br /> 24H EMERGENCY##800--468-1760-CH/SK/TFI-Contract retained by genes l-. confers :':Igef;c:( ,i,r<:Jr i k i) <br /> cwn initial transporter to add or substitute} additional transporters on ener:,•2.(:)r• 'w <br /> 15. 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 international 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 EPA Acknowledgment of Consent. <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)At am a small quantity generator)is true. <br /> GeneratoOfferor's Printed/Typed Name Signature Month Day Year <br /> IS I ru gat 101 <br /> 16.International Ship ents <br /> H 71 Import to U.S. ❑Export from U.S. P ry/exit: <br /> Z Transporter signature(for exports only): DaN leaving U.S.: <br /> W 17.Transporter Acknowledgment of Receipt of Materials <br /> LU <br /> I.— Trans rte Printed/Type Na Sign re Month Day Year <br /> a 0.h �p S Z t <br /> Z Transporter 2 Printed/Typed Name Signature Month Day YeAr <br /> � �✓c5 ti l9Z l LJ <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space <br /> Quantity ElType Residue Partial Rejection Full Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> tai Facility's Phone: <br /> w 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> Q <br /> Z <br /> y19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment.disposal,and recycling systems) <br /> LU LU 1 H141 2. 3. 4. <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> P' Name I I 1� A/)AX :DL/!)p::1fAL9A Signature Month Day Year <br /> EP ,F,rr��t S �22( /�1z 17) Previous editions are obsole e. DESIGN TED FACILITY TO EPA's e-MANIFEST SYSTEM <br />