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SSL SK SHIP# 218089935 ?311 11111111111111111111111111 Jill III I III <br /> 0 0 5 2 4 4 9 3 6 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 CAT000613968 2.Pagj 1 of 31Eaffe 2�xl Le1)f tt 4.Manifest Trackin Number <br /> WASTE MANIFEST 1���fi ��rl q 100 <br /> 5244936 SKS <br /> 5.�W�fV-TktW SMYEMS, INC. Gener oL$ t I YreKL �IY t'�Y �ss)INC. <br /> PO BOX 555 5050 SALIDA BLVD <br /> SALIDA CA 95368 <br /> GeneratorPhone: 809-545-1011 SALIDA CA 95368 <br /> 's <br /> 6.kimrLder""LitRe SYSTEMS, INC. U.S.EPA ID Number T X ROOOOB 1205 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address SAFETY-E CALIFORNIA, NC. U.S.EPA ID Number <br /> 6880 SMITH AVE. <br /> NEWARK , CA 94560510-795-4400 CAD980887418 <br /> Facility's Phone: <br /> ga. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes <br /> HM and Packing Group(if any)) No. Type Quantity Wt.Nol. <br /> 0 1 NON—RCRA HAZARDOUS(USED OIL) WASTE, LIGUID TT G 881 <br /> 0 <br /> Z 2. <br /> W <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional Information <br /> 24 HR EMERGENCY #1-800-468-1760 (SK 1 TFI) <br /> AUTH AS "AGENT—FOR" BY GEN TO RETAIN LICENSED SUB CARRIERS AS NECESSARY <br /> 15. GENERATOR'S/OFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, <br /> marked and labeled/placarded,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 consignment conform to the terms of the attached EPA Acknowledgment of Consent <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I a smal quantity generator)is true. <br /> Generato /Offeror's Printed/Typed Nape Signature Month Day Year <br /> Z, b <br /> 16.International Shipments <br /> F ❑Import to U.S. ❑Export from U.S. <br /> Z <br /> enitry/exit: <br /> Transporter signature(for exports only): fa(leavng <br /> U.S.: <br /> W 17.Transporter Acknowledgment of Receipt of Materials <br /> oTransporte 1 Printedffyped Name ` Signature Month Day Year <br /> a <br /> L &..4 1 0 L C;el 1 <br /> Z Transporter 2 Printed/Typed Name Signature Month Day Year <br /> 05 <br /> H <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑ ❑ <br /> Type Residue El Partial Rejection Full Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> V <br /> Facility's Phone: <br /> LO 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> Q <br /> Z <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> LU 1. 2. 3. 4. <br /> L UJB <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Pdnted/Typed Name <br /> am S' Month Day Year <br /> 2 c cif <br /> 0S <br /> EPF�rgy$ (�g22(13ev3 051 Previous editions are obsolete. DESIGNATED FACILIT TO DESTINATION STATE(IF REQUIRED) <br />