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SSL SK SHIFT# 220163566 53102 11111111 ME 111111111111111111111111 <br /> 0 0 5 5 2 3 6 4 4 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 TXR000081205 2.Pagelt of 3 fm ¢9sa f17@0 4.Manifest Tracking Number <br /> WASTE MANIFEST 0 05523644 S K S <br /> tftTEM6, I NC. GeneripgftftVrtR f ftt t"OgAss)I NC. <br /> PO BOX 555 5050 SALIDA BLVD <br /> SALIDA CA 95368 <br /> Generators Phone: 209--545-1011 SALIDA CA 95368 <br /> 6.T fe ilni SYSTEMS, INC. U.S.EPA ID Number TXR000081205 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address ZDHI�6980 YM I TH AVE. LHI_ r U.S.EPA 10 Number <br /> NEWARK , CA 94560 510-795-44@@ GAD980887418 <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 WtJVd. <br /> 0 <br /> (USED OIL) <br /> z z. <br /> W <br /> C7 <br /> 3. <br /> 4. <br /> 14,Special Handling Instructions and Additional Information <br /> 24 HR EMERGENCY #1-800-468-1760 (SK / TFI) <br /> RUTH A5 "AGENT—FOR" BY GEN TO RETAIN LICENSED SUB CARRIERS AS NECESSARY <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION:1 hereby declare that the contents of this consignment are fully and accurately described above by the propershipping name,and are classified,packaged, <br /> marked and labeled(placarded,and are in all respects in propercondition for transpon according to applicable intematlonaland national governmental regulations.If export shipment and I am the Primary <br /> Exporter,I certify thea the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Conse <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(rf i a s all quantity generator)is true. <br /> Generator Offerors Pdnted/Typed Name Signature on Day Year <br /> L_� 16>1117-IL HL, <br /> .J 16.International Shipments <br /> 1— ❑Import to U.S. ❑Export from U.S. n of entrylexit: <br /> Z Transporter signature(for exports only): Date leaving U.S.. <br /> w 17.Transporter Acknowledgment of Receipt of Materials <br /> T=ped PnntetllTyped Namg.— Slgoature Month Day Year <br /> N L a z b <br /> Transporter2 Pdntedrfyped Name Signature Month Day Year <br /> F <br /> 18.Discrepancy <br /> 18a.Discrepancy Indicatlon Space <br /> Quantity Type Residue ❑Penial Rejection ❑Full Rejection <br /> Manifest Reference Number. <br /> 18b.Altemate Faality(or Generator) U.S.EPA0 Number <br /> J_ <br /> LL Facility's Phone: <br /> w 18x.Signature of Atomate Facility(or Generator) Month Day Year <br /> 4 <br /> z <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment disposal,and recycling systems) <br /> 0 1. C) � 2. <br /> 20.Designated Facility - r or Operator:Cert€fication of receipt of hazardous materials covered by the manliest except as noted in item IBe <br /> Printedl typed Signature Month Day Year <br /> 4' e? 10717-1116 <br /> c <br /> EPfflinT$�7 � �Previous edition,are obsolete. DESIGNATED FACILITY TO DE TINATION STATE(IF REQUIRED) <br />