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SSL SK SHIP# 229110969 NINIINI�INII�IN�IIII�I <br /> Please print or type. 0 0 i Form Approved.OMB No.2050-0039 <br /> 1.Generator O Number 2.Page,l of 3.Erne en Res nse Phone 4.Manifest Tracking Number <br /> UNIFORM HAZARDOUS CAL000425303 1 1-801 _4 8-1760 SKS <br /> WASTE MANIFEST SKS <br /> Vv <br /> 5.Generators Name and Mailing Address Generator's Site Address(if different than mailing address) <br /> Gardner Trucking/Classic Sales In <br /> 2577 W Yosemite Ave <br /> MANTECA CA 95337-9641 <br /> Generators Phone: 209-249-3204 <br /> 6.Trans orter 1 Com an Name U.S.EPA ID Number <br /> Sf�FETY—KLIEEN SYSTEMS INC TXROOOO81205 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> It.Designated Facility Name and Site Address SAFETY—KLEEN OF CALIFORNIA U.S.EPA ID Number <br /> 6880 SMITH AVE. <br /> NEWARK , CA 94560 <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 WtNol. <br /> NON—RCRA HAZARDOUS WASTE, LIQUID TT G 222 <br /> o (OIL, WATER, SLUDGE) U <br /> 4a <br /> z 2. <br /> W <br /> Y9 <br /> 3. <br /> 4, <br /> 14.Spedal Handling lnstmctions and Additional Info lion TSD:EVG 80735264 GR15065 CSG: <br /> #JCY#800 43ti-1 <br /> 24H MERGEN Y#800-468-1760—CHISKITFI—Contract retained by generator confers agency al1thori y <br /> on initial transporter to add or substitute additional transporters on generator' s behalf. <br /> 15..E NERATOWSIOFFEROR'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 Iabeledlplacarded,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 car*that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. <br /> I car*that the waste minimization statement identified in 40 CFR 262.27(x)(if I am a large quantity generator)or(b)(if I am a small quantity generator)is we. <br /> Ggneretors/Oferors PrntedRyped Name Sgnature Month Day Year <br /> 16.Intemakona ipments ❑Import to U.S. ❑Export from U.S y Port of entry/exit: <br /> F <br /> z Transporter signature(for exports only): Date leaving U.S.: <br /> 0Z 17.TransporterAcknoWedgment of Receipt of Materials <br /> W <br /> K The der i Prntedrryped Name _ Sig re Month Day Year <br /> O <br /> a <br /> zTransporter 2 AptedfTyped Name Signature Month Day Yea <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection <br /> Full Rejaction <br /> n <br /> Mani Reference Number: <br /> 18b.Alumni Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> LL Facility's Phone: <br /> w 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> Q <br /> Z <br /> H19.Hazardous Waste Report Management Method Codes(i.e..codes for hazardous waste treatment,disposal,and recycling systems) <br /> � 1. j 'I � � 2. 3, 4. <br /> 20,Designated Facility Ownar or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> PrntedRyped Name SignaW - Month Day Year <br /> EPA Form 8700-22�Rev.12-17) Previouseditions areobsoete. DESIGNATED FACILITY TO EPA's e-MANIFESTSYSTEM <br /> 1)3287/1 0182 <br />