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SSL SK SHIP# 27708151 <br /> Please print or type. &-t7op pp U11111111111111111111111111 <br /> UNIFORM HAZARDOUS 1,Generator ID Number 6 7 7 6 9 2 7 S K S <br /> WASTE MANIFEST TXR000081205 2.Page11 of 3.€ R W�. Form Approved,OMB No.2050-003 <br /> �=�!111g�760 4.Manifest Tacking Number <br /> s.GPO BOX 5i°3 A���TEMS INC. Ganes �gpp $`d �g g� 0y�gn 6 7 7 6 9 2 7 SKS <br /> PQ IDX 555 ' (� t 1 Pk t `�YS��tRiS ss) <br /> SALIDA 5050 SALIDA BLVD , INC. <br /> Generator's Phone: 209-545-1011 CA 95368 <br /> 6.Tr rter Y�pftQ SYSTEMS INC SALIDA CA 95368 <br /> G company <br /> u.S.EPA IDNumbar TXR000081205 <br /> 7.Transporter 2 Company Name <br /> U.S.EPA ID Number <br /> 6,Designated Facility Name and sueAddress SAFETY—KLEEN DF CALIFDRNIR <br /> 6880 SMITH AVE. us.EPA ID Number <br /> Facility's Phone: <br /> 510-795-4400 NEWARK <br /> , CA 94560 <br /> ga. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, CAD980867418 <br /> HM and Packing Group(if any)) 10.Containers <br /> Total <br /> Fo N(USEDCDILHAZARDDUS WASTE, LIQUID n. ntity 12.unit <br /> K No. Type Quantity Wt Nol 13,Waste Codes <br /> a4 TT G 221 <br /> w <br /> w 2' <br /> 3. <br /> 4. <br /> 14,Special Handling Instructions anti Additional Informstion TSD:EVG <br /> SAL CSG: <br /> 24H EMERGENCY#800-468-1760—CHJSK/TFI—Contract retained 6 <br /> on initial transporter to add or substitute additional transporters on g <br /> 15. GENERATOR'efOFFEROR'$CERTIFICATION: Thereby tleclare that the contents of this consignment are fully and accuately described aboe byathe properchipp 9a me,arp are classified Packages,cy 9 til f. <br /> marked and 10lab that the part and are in all respects in proper cenditlon for transport according to applicable intematlonalantl national govemmenfal regulations.Ifexportryhipmenare cl am the behalf. <br /> ri Y <br /> Exporter,I t the that the wntents of this consignment con/arm to the terms of the attached EPgAcknowletlgment <br /> I cedity that the waste minlmizatlon statement Identified in 40 CFR 262.27(a)(If I am a large quantity b ' <br /> Generators eror's Printed/Typed Name geneator)orO( in smallcanti <br /> generator) We. <br /> Signature smallscantly <br /> ntemahonal Shipments Month �D�ayJ /Year <br /> ~ ' 0>� �7 / <br /> z Transportersignature(for exports only): Import to U.S. <br /> Export from U.S. Port o(entry/exit: <br /> w 17.TansporterAcknowledgmant of Receipt of Materials Date leaving U.S.: <br /> OTranspo r 1 Printed/Typed Name <br /> ra r Signature <br /> zQ orter PnntedrFyped Name Month Day Year <br /> f Signature 5, /9 <br /> } 18.Discrepancy Month Day Year <br /> I 18a.Discrepancy Indication Space <br /> ❑ Quantity <br /> ❑Type ❑Residue <br /> - ❑Partial Rejection <br /> )_ ❑Full Rejection <br /> � 186.Alternate Facility(or Generator) <br /> .� Manifest Reference Number' <br /> V <br /> LL Facility's Phone' U.S.EPA ID Number <br /> C3 18c.Signature ofAltemate Facility(or Generator) <br /> Q <br /> 2 <br /> h19.Hazardous Waste Report Management Method Ctles(i.e.;codes for hazardous waste treatment,disposal,and recycling systems) Month Day Year <br /> C-) <br /> 3. <br /> 1 <br /> 20.Designated Facility Owner::ppm1OI of receipt of hazardous materials covered by the manifest except as octad in Item i8a <br /> Print <br /> edName <br /> C Signa <br /> 7y��,y�u e� 1. I_ Month Day Year <br /> 4 I1 r�r 1!) Previous editions are obsolete. "'–�"`— U 19 <br /> DESIGNATED FACII-ITY TO EPA's e-MANIFEST SYSTEM <br />