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SSL SK SHIP# 226423489 11111111111111 1111111 <br /> Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Rhea� O O Form Approved. MB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number CAL000352832 2.Pagel of 3.jmeg f R,4gr i/G0 4.Manifest Trackin Number <br /> WASTE MANIFEST 0 063 1744 SKS <br /> 5.G a—rt T1'arfmAF'2 l inag/C l a s s i c S 1.e s I n Generators Site Address(if different than mailing address) <br /> 2577 W Yosemite Ave <br /> MANTECA CA 95337-9641 <br /> Generator's Phone:mxw�wk�a <br /> 209-249-3204 <br /> 6.Trrgi f[�TWRE#" SYSTEMS INC U.S.EPA ID Number TXR0000 IL'05 <br /> 7.TrEEpNGHMN91NImhS ENVIRONMENTAL SVC INC. U.S.EPA ID Number MAD039322250 <br /> 8.Designated Facility Name and Site Address THERMO FLUIDS INC U.S.EPA ID Number <br /> 12533 SE CARPENTER DR <br /> CLACKAMAS , OR 97015-8988 <br /> 503-788-4616 OR0000025197 <br /> Facili sPhone: <br /> ge 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.ContainersType T.Total 12.Unit <br /> HM and Packing Group(if any)) NoQuantity Wt.Nol13.Waste Codes <br /> . . <br /> 1. — E SOLID DM P 223 <br /> Cid (DRAINED/UNDRAINED USED bIL FILTERS) <br /> z z. <br /> W <br /> t9 <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional Information 77728038 GA15065 CSG: <br /> � -;6 ou a bel a <br /> 24H EMERGENCY#800-468-1760—CH/SK/TFI—Contract retained by generator confers agency authori y <br /> on initial transporter to add or substitute additional transporters ongenerator' s behalf. <br /> 15. GENERATOR'S/OFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and a Lely descn love by the proper shipping name,and are classified,packaged, <br /> marked and IabeleNplararded,and are in all respects in proper condition for bansport according to applicable interna a rid nation. amara" regulations.If export shipment and am Me Primary <br /> Exporter,I certify that the contents of this run nment conform to the terms of me attached EPAAcknowledgment of s n <br /> I ce the waste mi 'mization state Identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b) f a small middy generator)is We. <br /> Generator O8e es Prinped Name Signature Month Day Year <br /> Ila <br /> —r 16.Interna n pments <br /> F ❑Import to U.S. ❑Export from U.S. Port of arVylexit: <br /> Transporter signature(for ex only): Date legang U.S.: <br /> out 17.Transporter Acknowledgment of Receipt of Materials <br /> Transporter 1 Printed tl Na a Signature Month Day Year <br /> IL <br /> t i <br /> Qer nntedRyped Name Signature Mom ay Year <br /> y O`7 <br /> r <br /> 1 U.Uisoepancy + <br /> 18a.Discrepancy Indication Space <br /> ❑ Ouantiry ❑Type ❑Residue ❑Partial Rejection El Full Rejection <br /> Manifest Reference Number: <br /> 18b.Altemam Facility(or Generator) U.S.EPA ID Number -t <br /> J <br /> U ' <br /> LL Facilitys Phone: <br /> 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 /> G 1 I 2. 3. 4. <br /> 1 20.Designated Facility Owner or qvw Operator CaNfication of receipt of hazardous materials covered by the manifest except in Item 1 <br /> Pnnted/fypEtl(021he i signature Mopth Day Vear <br /> EPAF)om�8Z0032(Rew1�O5�Previouseditions are obsolete. GNATED FACILITY TO E <br /> 1 �tl/26/6 b .33 EPA E-Manifest System <br />