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0 <br /> SSL SK SHIP# 213157304 IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIiIIIIII <br /> a 0 4 2 5 5 4 4 6 S KS <br /> Please pant or type.(Freon deslpned for use on elle(12-pitch)typevmla..) Farm Approved.OMB No.2050-0035 <br /> UNIFORM LAZAP,%4IjS 1.GeneratalONumhe TXR000081205 ZPaggId 3. 80"Sal"PP60 4.MoufeetTracaing Number <br /> WASTE MANIFEST 1004255446 SKS <br /> 5GeremWs Slm Address((iId&rent than mea address) <br /> VAP�IW LF&WgTEMS, INC. SAFETY—KLEEN SYST�th1S, INC. <br /> PO DUX 555 5050 SALIDA BLVD <br /> SALIDA CA 95368 <br /> GeneramrsPhane: 209-545-1011 SALIDA CA 95368 <br /> e.T8Wt11krRL'ttff SYSTEMS, INC. U.S.EPA ID Number TXR000081205 <br /> 7.Tamponer2 Company Name U.S.EPA ID Number <br /> 8.Desgnaled Fadly Name and Site address 6880 SMITH AVE. CALIFORNIA, • U.S.EPAIDNmnber <br /> NEWARK , CA 94560 <br /> 510-795-4400 a CRD980887418 <br /> Fac81y's Phone: <br /> g,, gb.US.DOT Dnc ptlw(imWing Proper Slopping Nam,Hazam Close.ID Number, 1O.ConWinam 11.Total 12.Unit 13.WasteCodes <br /> mi and Pacing Groupleany)) No. Type Duandly ,}NI.Nof. <br /> d <br /> 1. (USED OIL) <br /> 0 <br /> 4a CTU j �Q <br /> z 2. <br /> w <br /> 3. <br /> a. <br /> 11.Special Handling lnseecOats and Add9i"Information <br /> 24 HR EMERGENCY #1-800-468-1760 (SAFETY—KLEEN) <br /> SK AUTHORIZED TO RETAIN LICENSED SUDSEOUENT CARRIERS AS NECESSARY <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION:I hereby dedam that the content,of NU Wmignment am fully and actuate, lescPded above by UapmpersNpping now.and aredassdleQ packaged, <br /> maned and labeledlpbcaaed,and are In al respects In proper m�lien lint iltn acoonnng to appliuma mtema' a reoonal govemmenbt agulalbn,If mpn shipment anal l am Ute Primary <br /> Expodu.I ceroty that the cements of this consignment conlorm0 the Lem of the agachad EPAAarowledgm. lofC L <br /> I Wray 01m the wage mbamizat'onstatement iduNfied in 40 CFR 262.27(a)(it i am a large oaanty fmorator)at(b) eamaY quantity gemtela)is lore. <br /> Canaf08amrs PnnfzdyTyped Name Sgmbre Monet Day Yea <br /> r <br /> J IB.RMFatoral Shipments 11��II <br /> F— ❑Imperlfo US. iJ& dBoon U.S. Mal enrylaa <br /> Tamporlers7unue(for exports only): alp awng US.: <br /> w 17.TmnspoMrAdmowledgmentotPe iddfhilariah <br /> K Ttemp r l Pnnledfly ald Name Sgrafure Monte Day Year <br /> O or <br /> b <br /> QTmmpa1ef2Pmledl7ypM ane 6gmhae MmN Day Year <br /> K <br /> H <br /> .H 18.Discrepancy _ <br /> 18a.DEoreWncy lneiudon Space ❑city ❑Type ❑Residue ❑PaNal Rejsdmn ❑Fug Rejacfian _ s <br /> N%Wmt Refererbe Number :,.......e� d <br /> 1Bb.Ma ane Fadbly(m Genuala) U.S.EPAIDNumber <br /> MAR 2 2 20111 <br /> LL Fad'Ityrs Phone: <br /> qq P9 <br /> W Ba Sgrolure ofAllemate edltty(a Genetelal M �, <br /> n <br /> 2 _ <br /> N19.2nu,Waste Report Management Method Codes(.e.codes for hauman waste treatment,disposal a:te agffing system) <br /> 0 1. 00r4 2 3, 4. <br /> 2D.Designated Facility Owner orOperamr.CsylrA eon receipt dhamrdous nplerads Waited by the mantas!except aXLW In he 183 <br /> Pmmdlfypap Name /+' /�, (�A�y� Sgnahire Nanth Day Year <br /> ffi <br /> Eq fgnP2 J3�I�4�9 Previous edifill.mdabwlete. SIGNATED FACILITY TO DESTINA ON STATE(IF REQUIRED) <br />