Laserfiche WebLink
SSL SK SHIP# 227324184 II1IIIIIIIII'I�I'�I�II�I1II'II�I�III <br /> Please print or type. v 0 0 6 7 7 5 6 6 2 S K S <br /> UNIFORM HAZARDOUS 1.Generator ID Number Form Approved.OMB No.2050-0039 <br /> e1 of 3€ ® <br /> WASTE FES <br /> MANIT TXRO00081205 2.P1g �� € 4.Manifest Trackin9 Number <br /> 5G§ 'KLEE '9"TEMS, INC. tp� c�r�nn�rg�(ytl�f�r� �myitp0p�d0dr¢6775862 SKS <br /> PO BOX 555 Generetons (Y aKLttry thM tlTi�) INC. <br /> SALIDA CA 95368 5 <br /> Generator's Phone: 209-545-1011 050 SALIDA BLVD <br /> s T` r1�1°��M SYSTEMS INC SALIDA CA 95368 <br /> U.S.EPA ID Number TXROOOOB1205 <br /> 7.Transporter2 Company Name <br /> U.S.EPA <br /> --Nu ber <br /> 8.Designated Facility Name and Site Adtlress <br /> 6880 SMITH AVE. u.S EPA ID Number <br /> 510-795-4400 NEWARK , CA 94560 <br /> Facililys Phone: CA 980887418 <br /> Ba 9b.US.DOT Descripton(including Proper Shipping Name,Hazard Class,ID Number, <br /> HM and Packing Group(if any)) IO.Containem 11 Total 12.Unit <br /> 1. — No. Type Quantity wt.Nol. 13.Waste Codes <br /> o (USED OIL, ' <br /> t— <br /> Iz <br /> W 2 3 <br /> CD <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional Information <br /> 24H EMERGENCY#800-468-1760—CH/SK/TFI—Contract retained by generator confers a ggency authori y <br /> On initial transporter to add or substitute additional transporters on generators behalf. <br /> p­mm the <br /> 15. GENERATOR'S/OFFEROR'S CERTIFICATION: cts in roper condition <br /> transport according <br /> ccordinsignment are fully and accuralelydescribedabo- by rhe proper shipping name,and are classified,packaged <br /> marked and labeled/placarded,and are in all respects in proper condition for of <br /> otached dirg to applicable international and national governmental regulators.If export shipment and I am the Primary <br /> Exporter, certify that the contents of this consignment conform to the terms of fhe attached EPA Acknowledgment of Consent. <br /> certify that the waste minimizationam statement identfled in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a a u 11 <br /> Generator's/0 rots Pdnted/fypetl Name q tygenerator)is We. <br /> Signature <br /> Month Day Year <br /> J 16.International Shipments ( <br /> ? ❑Import to USExpofrom US <br /> a L� <br /> Transporter signature exports only) p <br /> entry/exit: <br /> W 17.TransporterAcknowledgmenl of Receipt of Materials D leavin U.S.: <br /> Transporter PrintedRyped Neme <br /> O Signature <br /> a1111 01- Month Day Year <br /> Transporter 2 PrinledRyped Name <br /> C Signature <br /> r' Month Day Year <br /> } 18.Discrepancy <br /> I 18a.Discrepancy Indication Space <br /> ❑ Quantity ❑Type <br /> ❑Residue ❑Partial Rejection ❑Full Rejection <br /> F 18b.Alternate Facility(or Generafor) Manifest Reference Number: <br /> J <br /> & U.S.EPA ID Number <br /> LL Facility's Phone: <br /> 18c.Signature of Alternate Facility(or Generetor) <br /> Q <br /> Month Day Year <br /> V5 19.Hazardous Waste Report Management Method Codes(i e.,codes for hazamous waste treatment,tlisposal,and recycling systems) <br /> V5 1' <br /> 4. <br /> 20. signaled Facility Owner or Operator:Certification of receipt of hazardous <br /> Prinyped Name m:111 rialw <br /> s vemd by the manifest except as n ed in It 18a <br /> f¢d/I' �) <br /> CJ '� l / Slg <br /> EPbk EOF 0,2 MM.nth , Day Year <br /> 111 Previous editions are obsolete. 9Vl <br /> DESIGNATED FA01i ry TD EPA a e-MANIFEST SYS EM <br />