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SSL SK SHIP# 227706162 (� II�R111IIII'I'�III�I�'I��II'lII <br /> Please print ortype. <br /> OO6776935SK6 <br /> UNIFORM HAZARDOUS 1.Generator ID Number TXR000081205 2.Page11 of 3 Form Approved.OMB No.2050-00: <br /> WASTE MANIFEST € ghP`b0 4.Manifest Trackin Number <br /> 5.GPO B l Y—er�55 NEMS, INC. Genera _s � t t 0067 6938 SKS <br /> SA BOX 555 by OHf- K N7 -9V9MgA ' <br /> SA IDA + INC. <br /> Generators Phone 209-545-1011 CA 95368 5050 SALIDA BLVD <br /> s. "LnEtW <br /> SYSTEMS INC SALIDA CA 95368 <br /> 7.Transporter2 Company Name U.S.EPA ID Number TXR000081205 <br /> 8.Designated Facility Name and Sife Atldress U.S.EPq ID Numher <br /> 6890 SMITH AVE. us.EPA ID Number <br /> 510-795-4400 NEWARK <br /> CA 94560 <br /> Facility's Phone' <br /> ga. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, CAD980887418 <br /> HM and Packing Gmup(if any) 10.Containers <br /> 1. 11.Total 12.Unit <br /> o (USED OIL) + "0 Tvpe Quantity WLNol. 13.Waste Codes <br /> ag <br /> W <br /> � 2 ad 1 <br /> 3 <br /> 4. <br /> 14.Special Handling Instructions and Additional Information <br /> 24H EMERISE NCY#800-468-1760—CH/SK/TFI—Contract retained b <br /> on initial transporter to add or substitute additional transnorters ocnnfers agency authori y <br /> 15. GENERATOR'S/OFFEROR'S CERTIFICATION: herebydeclarethalthecontent oofthisconsignmer are fullyantl accurately tlescribed ahoveb the ro er shi m name,aware ttclassifietl,packaged <br /> marked a011 aI thaplacardeq and are in all respects in propercondition for transport according to applicable intemafionaland national governmental ulaticns. egenerd Or s behalf. <br /> Exporter, certify Thal the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Co nt. Y gadder <br /> pP g <br /> certry thatthe waste minimization statement identifiedin 40 CFR 282."i(if lam ala a uanli port shipment and I am the Primary <br /> Generator's eror's Printed/Typed`ame q h signature orb m a <br /> ) U( all quantity generator)is We. <br /> Signature <br /> _u 18.Intemational Shipments`• Month <br /> 'D`aY Year <br /> ~ Import to U.S. (J- Zj <br /> ? Transporter signature(for exports only): El Export from U.S. L✓ <br /> w 17.TmnsporterAcknowledgmant of Receipt of Materials ort of entry/exit: <br /> Cat ad U.S.: <br /> O Transporter Printed/Typed Name <br /> a <br /> L � Signature <br /> n <br /> Transporter rine yped Name <br /> Month Day Year <br /> F- Signature o3 bT 1 <br /> } 18.DiscrepancyMonth Day Year <br /> I 18a.Discrepancy Indication Space <br /> ❑ Quantity <br /> ❑Type <br /> ❑Residue <br /> ❑Partial Rejection <br /> 18b.Alternate l',olity(or Generator) ❑Full Rejection <br /> Manifest Reference Number' <br /> e <br /> LL Facility's Phone: LIS.EPA ID Number <br /> �j 18c.Signature of Alternate Facility(or Generator) <br /> Q <br /> 2 <br /> V519.Hazardous Waste Mara <br /> ant Method Codes(i.e., <br /> 131 2. codes far hazardous waste treatment,disposal,and recycling systems) Month Day Year <br /> W /\ <br /> V 3. <br /> 20.Desi noted Facility Owner or Operetoc Certification of receipt of hazallous materials covered by the manifest except as nUetl in Item 18a 4 <br /> Pri d ped Na ,^ <br /> EPl l <br /> pF �1p,2 Sign <br /> ��s j% editions are obsolete. Moan} Day --yI <br /> DESIGNATED FAGIL'F''TC EFA's e.MANIFEST SYSTEM <br />