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SSL SK SHIP# 4e40-ir-aoc <br /> 0071695lSSKS <br /> Please print or type. N <br /> Sao Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2,Page 1 of 3.Erne en Res once Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST CAR000039370 ?1 1-A�0Q�-4�8-1760 007181885 SVS <br /> 5.Generators Name and Mailing Address O'` Generators Site Acidness(it different than mailing address) 1� <br /> Escalun Premier Brands Inc. <br /> 1905 Mchenry Ave <br /> ESC_ALON CA 9530-0000 <br /> Generator's Phone: 209-552-6051 <br /> 6.Trans iter 1 Com ny Name U.S.EPA ID Number <br /> SNFFETYLEEN SYSTEMS INC TXROOOOB1205 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> CLEAN HARBORS ENV SVC INC. MAD039322250 <br /> 8.Designated Facility Name and Site Address CLEAN HARBORS ENVIRONMENTAL SFRVICFG, IN U.S.EPA ID Number <br /> 2:'47 S HIGHWAY 71 <br /> KIMBALL_ , NF 69145 <br /> 308-2. 5-4012 NF:0981723513 <br /> F . s Phone: <br /> ga 9b.US.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 Quantity Wt.Nol. <br /> X 1UN1992 WASTE FLAMMABLE LIQUIDS, TOXIC DM P D001 D018 D039 <br /> 0 IN O. (NAPHTHA <br /> 9 1ETRACHLb..bROETHYLENb , 3, (6. 1) , PG III � I 140 741 <br /> z Z <br /> w <br /> c� <br /> 3. <br /> 4. <br /> 14.Special Handling lnstmctions and Additional Information TSD:KF' 8084937 ES12014 CSG-. <br /> 1)ERG#131• ( <br /> �24H EMERG�NCY#800-468-1760-CH/SK,/TFI-Conttact retained by generator confespni-tFirg nn rs a ency authori ' <br /> n initial transporter tn and Or sulacititilt, lad s <br /> 15. GENERATOR'S/OFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and acct ately described above by the proper shipping name,ab are classified,packaged, <br /> marked and latmed bacarded,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 certgy 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)(if I am a small quantity generator)is true. <br /> GenuatoeslOBemrs Nfime� - - Signature I Month Day Year <br /> Qz`- ( Cj�yj �thp - <br /> F 16.International Ship fs <br /> ❑Import to US. Export from U.S. Port of entry/exit: <br /> ? Transporter signature(far exports only): Date leaving U.S.: <br /> K 17.Transporter Acknowledgment of Receipt of Materials <br /> W— Trailoit/eyr�1 PirlledlTyped(Name Signa Month Day Year <br /> I <br /> Z Transporter 2 Pn latlEiped Name gna Montthh/ Day Year <br /> t18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number'. <br /> T87Altemale Facility(or Generator) U.S.EPA tD Number <br /> J <br /> V <br /> ra+- Facilitys Phone. <br /> W i8c.Signature of Alternate Facility for Generator) Month Day Year <br /> Q <br /> 2 <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste heatment,disposal,and reading systems) <br /> mi 2. 3, 4. <br /> O ' <br /> 20.Designated Facility Owner or Operator:Cerfiflcagon of receipt of hazardous materials covered by the manifest except as need in Item 18a <br /> 1 Pdnted(Typed Name Monk Day Year <br /> EPI Form 870 <br /> 881 0- <br /> 22 Rev. <br /> 18?92721 us editions are obsolete. ESIGNATED FACILITY TO EPA's e-MANIFEST S STEIA <br />