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SSL 5K SH[F.# 224951158 1111111111111111111111111111 <br /> Pleas0 not or Form desi neo for use on elite(12-pitch) 0 0 6 o 9 5 u 0 b S K 3 <br /> p typo.( g ( -p )rypewmer] Farm Apprpved-OMB No.2050-0G39 <br /> UNIFORM HAZARD0115 1 Ceneator lO Numhn C 2 P f of 9.Em rpan yResp�sep�o a C Manifest Tracking Number <br /> WASTE MANIFEST CA0982�01736 1 1– tSd-4,`.�Li–1/hll 00659500 SKS <br /> 5 Genaratprs Name and Mailing AC,dresi C,aneraloys Site Address Ig diHerenl Nan matting address) <br /> Cal-Trans Shap 10- 30110 Cws <br /> 1603 S B St <br /> SSTOCKTON CA 95;706_^47A <br /> Generators Phone 209-94$-7813 <br /> 6.Trans�rter 1 Com n ame U.S.EPA TO Number <br /> SAT ?N SYSTEMS INL' TXR000D81205 <br /> r.7ansporter2 Company Name I� US EP N be <br /> e THERMO FLUIDS INC u.S EPAIDNemher <br /> 12533 SE CARPENTER DR <br /> CLACKAMAS OR 97015-8988 <br /> 503-788-4616 0€20000021197 <br /> Faa&Vs Pheme: <br /> ga 9b U.S.DOT Oe vgtlun fecIL&II Prmgrer Sreppm9 Name.Hazard Ciass,ID Number, 10.Containers 17.Total 12 URI <br /> 13.Waste Codes <br /> ypd and Peckmg Group UI aHyl) No. Type 9uantiry tSR rVoI <br /> 1 NON-RCRA HAZARDOUS WASTE, SOLID 1)rl P 223 <br /> (DRAINED/UNDIRAINFD USED OIL FILTERS) _— <br /> i 2 <br /> w <br /> 3 <br /> A <br /> 14.Speaal)Handling lnswctidns and Additional lntcrmaiidn TSD:TPO '67346260 CA47954 201814 C50:29 <br /> 24 HR EMERGENCY #1-800-448-1760 (CH l SK / TFI) `U 6 1 ""—7 <br /> AUTH AS "AGENT-FDR" BY GEN TO RETAIN LICENSED SUB CARRIERS AS NECESSARY <br /> 15. GENERATOR'SiOFFEROR'S CERTIFICATION:I hemby deciam that the conlents of tttis r igrimant are 114y and aocumlety described above by the proper Shipping name,and are tlasie6ed,packaged, <br /> marked and Izbeledplacarded,and are in alt respects in proper cordition for oanspod acctxding to applicable iriiamaliorra3 and nalional govemmental regulations.M export Shipment and I am the Primary <br /> Exporter,I certify Nal Ne mnlents of this consignment conform to the forms of ase attached EPAAcl npwledgment of Calsent <br /> I certify that Ne waste nr+Arnzalim slates m idwvIted in 40 CFR 262 27(a){d I am a large quariery generalor)or(b)(II an,a sinal quantity geneatw)is true. <br /> Goner s Pdnt yped Name Sgnaarre�� Month Day Yoar <br /> oy`t .e� <br /> F 16 hnt afinnal Shipments ❑I mat to U.S. <br /> ❑ExPod hon U.S. Pertof entryfexiL _ <br /> Z Transporter sxinalure(far capons onfy) Date leaving U S <br /> Of }7.Tanspoder AckrazOi rrwt of Reo5pt of Mav:s'.:.. <br /> Tra r f PrinledlT Name Signature Month Day Year <br /> ILv�2 2 <br /> H <br /> Q Transpolar 2 Fnni Ry Signature Month Day Year <br /> a �rr,f <br /> 15.Otsmoncy <br /> 18a DwriDarcy Tnd,r Sw Spars ❑Q—My ❑Type ❑Residue ❑Partial Roeaian ❑Ful1 Rapdtion <br /> Marfe5t Reference Number: <br /> 18b.Altemale Faalily(or Gonemiorl U.S.EPA ID Number <br /> J <br /> U <br /> vd.. yace,ry'svrionu <br /> fBc.S�gnatura of Abmme FaCAity for GerieraW*l Month Day Year <br /> 4 <br /> Z <br /> 19-Hazardous Haste Repan Management Method Codes p.e.,codes for hazardous waste eeatmeM.drposal,and rang systems) <br /> 20.DMnated Facility Owner or Operator CerMiea0on of receipt Of hazardous maleda€s coverad by Ne manifast except as nded'n ilem 18a <br /> PreltedR'yped Name SgnaWre Month Year <br /> EP�FgG3PR6(/1.56La viousedifionsar obsolete, DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />