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IIII�IIII�IIIIII'IIIIIII II IIII II ILII <br /> 0053292325 KS <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.Pag 1 of 3.,Emergency Response Phone_ 14.Manifest Trackin Number <br /> WASTE MANIFEST <br /> TXPIt�081 +� 005329232 SKS <br /> 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) <br /> ',TEM1 � INC. ;r� L ;'-F'�FEr" St;� `h;. , ;Nc <br /> DO BOX555 5050 SALIDA BLVD <br /> r ''A 95368 <br /> Generator's Phone: �?-cyfc-IfAII SAL IDA CA 95368 <br /> 6.Transporter 1 Company Name I Nr U.S.EPA ID Number T x R00008;=Q!- <br /> 7. <br /> T!-7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Facility Name and Site AddressSAFETY-KI_EEN OR Cn? nn?I A, I1 U.S.EPA ID Number <br /> 6880 SMITH AVIF <br /> NEWO PU CA 94560 <br /> +10--795-44 10 CAD98O8°7t:18 <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 Quantity Wt.Nol. <br /> 11. fdON-BORA HH-7.ARDOUS TASTE, LTnUI '=,' <br /> o (USED OIL) <br /> Z 2. <br /> w <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional Information TSD;EVG -Fl_ F „ <br /> YP a oresl,-v f41.-400-468-1760 (SK ! TF1) <br /> - BY GEN TO RETAIN LICENSED SLIB CARRIERS <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION:I hereby declare that the contents of this consignment are fully and accurately desabed above by the proper shipping name,and are classified,packaged, <br /> marked and labeledlplacarded,and are in all respects in proper condition for transport according to applicable intemabonal 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 EPAAcknowiedgmen of t. <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generat)r) (b)V am a small quantity generator)is true. <br /> Gen=es/Offeroes ntedlTyped Name SignatureM..onJJth Day Year <br /> l-- - <br /> J 16.Inlemational Shipments <br /> f- ❑Import to U.S. ❑Export from U.S. Port of entrylexd: <br /> z Transporter signature(for exports only): ✓ Dato leaving JJ.S.. <br /> W 17.Transporter Acknowledgment of Receipt of Materials <br /> Cr Transport 1 Printed(Typed Name Signature l Month Day Year <br /> 0. <br /> I o /b <br /> Z Tran iter 2 Printed/Typed Name Signature Month Day Year <br /> 77 <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity Type j j <br /> ❑T El El Re action Full Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J_ <br /> Facility's Phone: <br /> w 18c.Signature of Altemate 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 /> C 1. 2, 3. 4. <br /> r <br /> 20.Designated Facility Owner or Operator.Certification of receipt of hazardous materials covered by the manifeso-xaN as noted in Item 18a <br /> Pd yppd Name Sign re j Month Day Year <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. D5SIGNATEgYACILITY TO DESTINA STATE(IF REQUIRED) <br />