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x fig!. SK SHIP# 2226061303 <br /> Please print or type.(Form designed for use on elite(12-plt&)typewriter.) Farm Approved.OMB No.2050-0039 <br /> 'UNIFORM HAZARDOUS 1 Generator ID Number 3. g I �pQse PhgPe. _ 4.Manifest Tracking Number <br /> WASTE MANIFEST TXR00008120� Page1of 1011837270 F L E <br /> 5-Generatoes Name and Mailing Address Generator's Site Address tot different than mailing address) <br /> SAFETY-KLEEN SYSTFMS, INC. SAFETY-KLEEN SYSTEMS, <br /> PQ BOX 555 5050 SALIDA BLVD <br /> SAL IDA CA 95368 <br /> Generalor'sPhone: �t4--545-1011 SRI-IDA CA 95368 <br /> 6. rams er 1 am tVama U-S.EPA 10 Number <br /> 5 FFTY-Ml�19-N SYSTEMS INC TXROOOOS1205 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address SAFETY-HLEEN OF CPLTFORNI A U.S.EPA I0 Number <br /> 6880 SMITH AVE. <br /> NEWARK , CA 94560CPD980887416 <br /> 510-705-4400 <br /> Facility's Phdne' <br /> 9a 9b.U.S.DOT Description(including Proper Shlpong Name,Hazard Class,10 Number, to-Containers 11•Total 12.Unit <br /> HM and Parking Group(if any)) 13.waste Codes <br /> No. Type quantity wt.fUot <br /> a ' NIDN--RCPA HnZARD13US WASTE, LIQUID TT 13 221 <br /> a (USED OIL) <br /> x z <br /> O <br /> c� <br /> 3, <br /> 4 <br /> 14.Special Handling Instructions and Additional Information <br /> T5D:EVS SAL CSG: <br /> 24H EMERGENCY#800-468-1760-CHISK/TFI-Contract retained by generator confers agncy authors y <br /> -an initial r' Qr I r tr r - s n e a s <br /> 15- GENERATOWSI IFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are dasshw,packaged, <br /> marked and Iabeledlplacarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations.If export shipment and I am the Primary <br /> Exporter,I certify that the contents of this co"nmenl confnm to Ura[arms of the attached EPAAdmowtedgmanl of Consent. <br /> I certify that the waste rn nimizapon statement idem AO CFR 262.27(a)tit I am a large quantity ggu&4Qag tbl(If I am a small quantity generator)is true. <br /> erors Printed yp erne gna ure _ nn ay year <br /> I 7� <br /> + <br /> alronal Shipme — -= <br /> F— ❑import to U.S. ❑Export from li Port of enlrylexiY <br /> x Trans arter signature for exports only): <br /> Date leaving U-S.: <br /> 17.Transporter Acknowledgment of Receipt of Malanahl <br /> 1 Pnnte'f''d Nam nature on ay Year <br /> JI& I r <br /> Q er 2 Print/' erne gnawrMonth Day Mr <br /> rY <br /> H <br /> 18-0iscrapancy <br /> taa.Discrepancy Indication Space ❑ ouenlily ❑Type Patial ReatioFull Reject. <br /> 18b.AAemate Facility(or Generators Manifest Reference Number <br /> U-S.EPA 10 Number <br /> J_ <br /> r.] <br /> Q <br /> � Pacilil's Pfrone: <br /> W 181.Signature afAltemata Facility(or Generatorl Month Day Year <br /> a <br /> x <br /> 19.Hazardous Waste Report Management Method Codes{i.e.,Codes for hazardous waste treatment,disposal,and recycling systems) <br /> � 1 F, 3 2 3 4, <br /> 20.Designated Facility Owner or Operator-Certification of rec hazardous materials covered by the(ran fast except as noted in€tern 1 Ba <br /> Printed/Typed Name Signature Month Day Year <br /> } 2- 1p <br /> EPA Form 8700-22(1�Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br /> 1 �i 3 •,� <br />