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0 <br />SSL SK SHIP# 212293294 <br />nawwa <br />p <br />UNIFORM HAZARDOUS <br />1. Generator ID Number <br />TXROOOO81205 <br />2. Pa 1 of <br />3 Em a cy se a <br />- ��- '- Q <br />4. Manifest Tracking Number <br />0 0 4131514 SKS <br />WASTE MANIFEST <br />5. Generator's Name and Mailing Address Generators Site Address (d different than mailing address) <br />SAFETY-KLEEN SYSTEMS, INC. SAFETY-KLEEN SYSTEMS, INC. <br />PO BOX 555 5050 SALIDA BLVD <br />SALIDA CA 95368 <br />Generator's Phone: 209-545-1011 SALIDA CA 95368 <br />6'VP9RMWSYSTEMS, INC. U.S. EPA ID Number TXROOOOB1205 <br />7. Transporter 2 Company Name U.S. EPA ID Number <br />S. Designated Fadlity Name and She Address SAFETY-KLEEN OF CALIFORNIA, INC. U.S. EPA ID Number <br />6880 SMITH AVE. <br />NEWARK , CA 945[,0 <br />510-795--4400 CAN80887418 <br />Faaf s Phone: <br />go. <br />$b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, <br />10. Containers <br />11. Total <br />12. Unit <br />13. Waste Codes <br />No. <br />Type <br />HM <br />and Packjng Group (ff any)) <br />Quantity <br />Wt Nol. <br />1' [BION-RCRA HAZARDOUS WASTE, LIQUID <br />TT <br />C� <br />221 <br />o <br />(USED OIL) <br />a <br />2 <br />as <br />3. <br />ENA <br />AUG 0 7 2015 <br />r <br />14. Special Handling Instructions and Additional Information TSD: EVG SAL CSG.- &nr <br />24 HR EMERGENCY #1-800-468-1760 (SAFETY-KLEEN) <br />15. GENERATOR'SfOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name, and are dassMeid, packaged, <br />nd national governmental regulations. M export shipment and I am the Primary <br />marked and tabaledlplacarded, and are In all respects in proper condition for transport according to applicable injbIfi(IoLffillaern <br />Exporter, I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment. <br />1 certify that the waste minimization statement identified in 40 CFR 262.21(a) ('d I am a large quantity generator) a small quantity generator) is true. <br />Generator Offerors PrinteMyped I me Signature Month Day Year <br />—J <br />F- <br />16. International S ipments <br />❑ Import to U.S. ❑ Export from U.S. Part nt <br />E <br />rn.�ylexit: <br />Transporter signature (for experts only): Date ving U.S.: <br />W <br />17. Transporter Acknowledgment of Receipt of Materials <br />� <br />a <br />Trani PrintedlTyped i rt Signature Month Day Year <br />de vL Z.qi I& <br />QTransporter <br />� <br />2 Printedllyped Name Signature Month Day Year <br />H <br />18. Discrepancy <br />16a. Discrepancy Indication Space ElQuantity1:1Type ❑Residue ❑ Partial Rejection ❑ Full Rejection <br />Manifest Reference Number. <br />18b. Altemate Facility (or Generator) U.S. EPA ID Number <br />7 <br />U <br />GFacility's <br />' <br />Phone: <br />W <br />16c. Signature ofAlte=to Fatality (or Generator) Month Day Year <br />y19. <br />Hazardous Waste Report Management Method Codes (i,e., codes for hazardous waste treatment, disposal, and recycling systems) <br />Wo <br />1, Oe --T <br />2. 3. <br />4. <br />2D. Designated Facility Owner or Operator. Certification of receipt of hazardous materials covered by the manifest except as noted in Ito 18a <br />Printadfr Name Signature Month Day Year <br />r1Aw1 f�T11TC n� � r coo n+ <br />EPA "m181UU-'1"L (Frey. '-fill) t-reviou5 eaiuons are ousaece. <br />1]11249/150105 <br />Page 49 <br />