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SSL SK SHIP# 229168980 `aV Iloilo 1111 1111111I11'111 <br /> Please print or0 0 7 1 6 1 7 5 7 OMB <br /> type. Form Approved. 0.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 1 3.E Res rise Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST TXRe00081205 1 1 a 4e8-1760 7181757 SKS <br /> 5.Generators Name and Mailing Address Generators Site Address(d different than mailing address) <br /> SAFETY—KLEEN SYSTEMS, INC. SAFETY—KLEEN SYSTEMS, INC. <br /> PO SOX 555 5050 SALIDA BLVD <br /> SALIDA CA 95368 <br /> Generators Plane: 209-545-1011 SALIDA CA 95368 <br /> S Trens orter 1 Com an Name U.S.EPA ID Number <br /> SF�FETY—KpLYEEN SYSTEMS INC TXR000081205 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address SAFETY—KLEEN OF CALIFORNIA U.S.EPA ID Number <br /> 6880 SMITH AVE. <br /> NEWARK , CA 94560 <br /> CAD980887418 <br /> 510-795-4400 <br /> Facility's Phone: <br /> ga, 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 1 . 13 Waste Codes <br /> HM and Padding Group(ti any)) No. Type Quantity <br /> 1NON—RCRA HAZARDOUS WASTE, LIQUID TT 221 <br /> of (USED OIL) dV <br /> � 60 <br /> z Z. <br /> W <br /> t7 <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional Information TSD:EVG SAL CSG: r <br /> 24H EMERGENCY#800-468-1760—CH/SK/TFI—Contract retainedby generator confers a ency arjthori y <br /> an initial ranspartpr to add or substitute additinna hehalf. <br /> 15. GENERATOR'SIOFFEROWS 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 condPoon for transport according to applicable intemational and national governmental regulations.It 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 Cont <br /> I certify that Mmen <br /> e waste minimization statement identified in 40 CFR 262.27(a)(d I am a large quantity generator)a(b)(dl a Will quantity generator)is true. <br /> Generaarsl rs Printed/fyped Nam <br /> Signature Month Day Year <br /> tie /�/ l9 <br /> 16.International hip ants <br /> F <br /> 1:1 Import to U.S. [J Export from U.S. Pod ofenby/edt: <br /> ? Tmnsponer signature(for exports only): Date Ieavi g U.S.: <br /> W 17.TransporterAcknoWedgment of Receipt of Materials <br /> Transporter 1 Priyped Name Signature Math Day Year <br /> o 0, 1 <br /> It. <br /> Tran rte Name SignahWre Month Day Year <br /> i18.Discrepancy18a.Discrepancy Indication Space ElQuantity 1:1Type Residue ElPtialRejecon ElFull Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> LL Facility's Phone: <br /> W 18c.Sgnahire of Alternate Facility(or Generator) Month Day Year <br /> Q <br /> 2 <br /> H19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> G 1. Q 2. 3. 4. <br /> 20.Designated Facility Owner or Operator.Certification of receipt of hazardous materials covered by the man"dest except as ncled in Item las <br /> Printed/Typed Name Signature - .; Month Day Year <br /> Ik G <br /> EPA Form 8700-22 Rev.12-17) Previous editions are obsolete. DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM <br /> 1) 11249/156017 <br />