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SSL SK SHIP# 218089924 ���� IIIIIIII III IIIIIIIIIIIII1IINIII <br /> 0052449 i 0 S K5 <br /> Please print or type.(Form designed for use on elite(12-pitch)typewriter) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1 1 Generator ID Number CATOOO613468 2.Pool 0l 31 OOy�dAal lbn0 d.Manifest Trackin Number <br /> WASTE MANIFEST y �p� 5;,� yen g p�"6 0 5 2 T 4 9 3 0 S K S <br /> 51"� gSEMS, INC. GeneaettlYa LEtNtSYSItI'IS;ss,INC. <br /> PO BOX 555 5i1-0150 SALIDA BLVD <br /> SALIDA CA 95368 <br /> Generators Phone. 209-545-1011 SALIDA CA 95368 <br /> T9PWTy-1WE1Nv SYSTEMS, INC. U.S EPA ID Number TXRO0OOS12O5 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Fwkly Name and Site Address — , U.S.EPA ID Number <br /> 6880 SMITH AVE. <br /> NEWARK CA 94560 <br /> 510-795-4400 CAD98O887418 <br /> Facmys Phone. <br /> ga. 9b.U.S.DOT Descnldon(including Proper Shipping Name,Hazard Class.ID Number 10.Containers 11.Total 12.Wkl 13.Waste Codes <br /> HM and Packing Group(d ant)) No. Type Quantity W1.Nd. <br /> —1 NON-KGRA HRLARUUUS WASTE, LIQUID TT G 221 <br /> o (USED OIL) <br /> o� 33 <br /> Z 2. <br /> w <br /> 3. <br /> I <br /> 4 <br /> k <br /> 14.Special Handling Instructions and Additional Information CSG: I <br /> 24 HR EMERGENCY #1-800-468-1760 (SK / TFI) <br /> AUTH AS "AGENT-FOR" BY GEN TO RETAIN LICENSED SUB CARRIERS AS NECESSARY <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consgnment are fully and accurately described alive by the paper shipping name,and are classified,packaged, <br /> marked and abelxllpubuirded,and are in all respects in proper condition for transport actio ditg to applicable international and national governmental regulations.If export shipment and I am the Primary <br /> Fxporter,I sanity that the contents a this consignment conform W tear farm of the atlactkd EPAAcumnMedgment of sent. <br /> I cedify that the waste mmunization statement identified in 40 CFR 25227(a)y l am a large quantity generator)of( I a15-small quantity gecrefafor)is eratorrors true. <br /> GenPdntedrryped Name Sgnature Month Day Year <br /> L� O12-C)111 <br /> j 16 International Shipments <br /> Z ❑Import to US. ❑Export ham U.S Pon of enbylexit <br /> Transporter Sgnature(for exports only). Data leaving U.S.'. <br /> w17.Tmnepoll Ackww"rbent of Receipt of Materials <br /> K Tra podIP ted'TypedName Signature Month Day Year <br /> o 129 <br /> aZ Transporter 2 PnntedRyped Name Signature Month Day YWr <br /> K <br /> H <br /> 18.Discrepancy <br /> 18a.Discrepancy Ibelation Space ❑ OuaMay, ❑Type ❑Residue ❑Partial Rated. ❑Ful Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate FaciNy(a Generator) U.S.EPA ID Number <br /> J <br /> V <br /> rat Famys Phone, <br /> but 1k Signature of Aaemate Fatlllry(or Generator) Monm Day Year <br /> Q <br /> 2 <br /> 19.Hazardous <br /> Waste Ration Management Method Codas(k .,co <br /> edes fa hazardouswaste trea nt,disposal,and recycling systems) <br /> G 1 (1 , d3 2. a. 4. <br /> 20,Designated FadlityOwner a Operetor:Cwtkaw of receipt of hazardous materials covered by the manifest except as cited in Clem the <br /> PrirdeNTyped Name-Toynatuce Month Day Year <br /> �7 mos�E� ( �9 116 <br /> EPMV7W2,(fvORf9 loeviousedltions are obsolete. DE' TED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />