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SSL SK SHIP# 224962811 U /�a • II III II III(�'�I�III IIII 11�I�)I I��I� <br /> 0 0 4 4 9 4 6 0 8 S K S <br /> Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page l of 3. 4. nffeat Tracking Number <br /> WASTE MANIFEST T X 8000081205 in-` 'ihg0 0 0 4 4 9 SKS <br /> 5.Generators Name and Meiling Address Generators Site Address(9 ditrent than mailing address) <br /> SAFETY—KLEEN SYSTEMS, INC. SAFETY—KLEEN SYSTEMS, INC. <br /> PO BOX 555 5050 SALIDA BLVD <br /> SALIDA CA 95368 <br /> Generators Phone: 209-545-1011 SAL I DA CA 95368 <br /> 6.TretWter�,Cjarrlggnyllaqnp SYSTEMS, INC. U.S.EPA ID Number TXROOOOB1205 <br /> 7.Traansspoortteer 2�ComppannyCName U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address SAFETY-KLEEN OF CALIFORNIA, INC. U.S.EPA ID Number <br /> 6880 SMITH AVE. <br /> NEWARK , CA 94560 <br /> 510-795-4400 CAD980887418 <br /> Facility's Phone: <br /> ga, 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers it.Total 12.Unit 13.Waste Codes <br /> HM and Packing Group(d any)) No. Type Quantity Wtivol. <br /> 1 NON—RCRA HAZARDOUS WASTE, LIQUID TT G 221 <br /> o (USED OIL) <br /> Z 2. <br /> W <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional Information TSD:EVG SAL CSG: 60 <br /> 24 HR EMERGENCY #1-800-468-1760 (SAFETY—KLEEN) <br /> 15. GENERATOR10FFEROW3 CERTR1C MN:1 hereby declare that the oor4ents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, <br /> marked and IabeWplacarded,and are in all respects in proper condition for transport according to applicable in and national governmental regulations.if export shipment and 1 am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAt. <br /> I certify that the waste minimization statement idended in 40 CFR 26227(a)(if I am a large quantity generator) (b)Cy.,am a small quantity generator)is true. <br /> slORerors PrintedfTyped Name Signa Month Day Year <br /> —1 16.International Shipments <br /> ❑import to U.S. ❑Export from U.S. Pon of entry/exit: <br /> Z Transporter signature(for exports only): to leaving U.S.: <br /> 17.Transporter AdmowWgmert of Receipt of Materials <br /> Trer 1 PrintedlTyped Name 1 Sig Month Day Year <br /> y c p 1"Z ifs <br /> ZQ T N Name Signatu Month Day Year <br /> tr <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number. <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> FwWs Phone: <br /> Ujj 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> 4 <br /> Z <br /> h19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> G 1. 2. 3. 4. <br /> N� 3 <br /> 20.Designated Facility 6wner or Operator.Certification of receipt of hazardous materials covered by the manifest except as rwted in item 18a <br /> Ir <br /> Wyped Nan* Signa Month Day l- <br /> EPA <br /> 0G 7r Form 8700-22(Rev.3-05) Previous editions arefabsolete. WESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br /> 1)11249/156017 <br />