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SK SfIIP# 213845456 I�IIIIIIIIIIII�I��I�IIIIIIIIIIIIIIIII <br /> 0 0 4 3 7 4 1 3 0 S K S <br /> Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number - 2.Page,1 of 3.finergq{ycy Rgspc a Qhq- 4.Manifest Tracking Number <br /> T X ROOOO131 r'Qi SKS(� <br /> WASTE MANIFEST S KS <br /> 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailingaddress) <br /> r6�F=T'i K Ef Pa C'YSTEMS, TNC. ,SAFETY—I;LE��fJ S1'STEM5, N. <br /> PO BOX 555 5050 SALIDA BLVD <br /> SALTDA CA 95368 <br /> Generators Phone: 209-545-1011 SALIDA CA 95368 <br /> 6.Tr o n U.S.EPA ID Number <br /> ?" °f`r?t cYSTE!"S, TNC, TXROOOO81205 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8 Designated Facility Name and Site Address SAFETY—KLEEN OF CAL I FORN T A. I NC, U.S.EPA ID Number <br /> 6880 SMITH AVE. <br /> NEWARK , CA 94550 <br /> CAD980887418 <br /> 510-795-4400 <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 <br /> 13.Waste Codes <br /> HM and Packing Group(if any)) No. Type Quantity Wt.Nol. <br /> 1_ NON—RCRA HAZARDOUS WASTE LIQUID 7T <br /> o (USED OIL) <br /> 7 Y60 <br /> Z 2. <br /> LU <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional Information TSD EUG SAL <br /> =4 HR EMERv-NC`f #1-8017-468-1760 (SAFETY--Ki_EEtk: <br /> TO IFT-0TR1 1 rr NC r` •*1C r.- rT C. T ^ ,art r,r C.SAr�.Y <br /> _, .AFI! Uc SF r7t r C�?.'F 1 A NECESSARY <br /> 15. GENERATOR'SIOFFEROR'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 intematio al 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 EPAAcknowledgment of C sen <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b) I a a small quantity generator)is We. <br /> GeneraIOffs/ erors Printed/Typed Name Signature Month Day Year <br /> 4 <br /> J 16.In atonal Shipments <br /> 1-1Import to U.S. ❑Export from U.S. Port of entry/exit: <br /> Transporter signature(for exports only): DatqlleaviU U.S.: <br /> W 17.Transporter Acknowledgment of Receipt of Materials <br /> 1.- Trans er 1 Printed/Typed Name Signature Month Day Year <br /> �_ <br /> I �--• ` o / <br /> Z Transporter 2 Prinledlryped Name Signature Month Day y6ar <br /> 7- <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity El Type 1:1 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 /> 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 1. 2. 7-- <br /> 20. <br /> Designated Facility Owner or Operator:CerfificWnyd receipt of hazard materials covered by the manifest except as noted in Item 18a <br /> Printed/Typame Signature Month ay Year <br /> EP/ F,o�rr387Q0��(fjtzv#3QS�.Previousedi o sareobsolete. SIGNATED FACILITY TO DESTINATION STATE(IF REQUI ED) <br />