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SSL SK SHIP# 227708145 <br /> Please print or type. II�III�IIiIIII'IIUINIIISKS <br /> I�I�IIIII�II <br /> Form Approved.OMB No.2050-0039 <br /> T15. <br /> NIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3. m R e P 4.Manifest Tracking Number <br /> WASTE MANIFEST TXR000081205 1 € = `—i `0 006776921 SKS <br /> G n r s Name and M lin A dress Generators Site Address if different than mailin address) <br /> A TY—KLE IV gYSTEMS, INC. SAFETY—I�LEEN SYST�I INC. <br /> PO IDX 555 5050 SALIDA BLVD <br /> SALIDA CA 95368 <br /> Generator's Phone. 209-545-1011 SALIDA CA 95368 <br /> 6Treceoe f,,InrrRtj a. SYSTEMS INC U.S.EPA ID Number TXR000081205 <br /> 7.Tra�nsMpCo'rteCr2 Company Name U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address SAFETY—KLEEN OF CALIFORNIA US,EPA ID Number <br /> 6880 SMITH AVE. <br /> NEWARK , CA 94560 <br /> CAD980887418 <br /> 510-795-4400 <br /> Facility's Phone: <br /> 9a, gb.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit <br /> HM and Packing Group(If any)) No. Type Quantity Wt.NDI. 13.Waste Codes <br /> 1. NDN—RCRA HAZARDOUS WASTE, LIQUID TT <br /> o (USED OIL) G 221 <br /> 9 <br /> w <br /> 0. <br /> 4. <br /> 14.Special Handling Instructions and Additional Information TSD 7 EVG SAL CSG 7 <br /> 24H EMERGENCY#800-468-1760—CH/SK/TFI—Contract retained by generator confers aggency authori y <br /> on initial transporter to add or substitute additional transporters on enerator' s behalf. <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 shippi f:nrng ,aMareclassis packaged, <br /> marked and labeled/placarded,and are in all respects in proper condition for transport according to applicable intemational and ion avemmenral regulations.If expod shipment and am the Primary <br /> Exponer, certify,that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent <br /> I certify that the waste minimization statement identified in 40 CFR 252.27(a)if I am a large quantity generator)or(b)(if a V11 generator)is true. <br /> Generate /Offerors Pme ypetmame Signature ` Month Day Year <br /> L t1111 <br /> J 16.international Shipments <br /> 1— ❑Import to U.S. ❑Export from U.S. ort of an hy i <br /> Transporter signature exports only). Date leaving <br /> Ix 17.TransponerAckin dgment of Receipt of Materials <br /> 17 <br /> OTransported Printed ped Name W( Signature Month Day Year <br /> W Transporter rinledlTyped Name Signature <br /> Q 9 Month Day Year <br /> K <br /> f <br /> } 18.Discrepancy <br /> 18a.Discrepancy Indication Space <br /> Quantity Ll Type El Residue ❑Partial Rejection El Full Rejection <br /> Manifest Reference Number <br /> 181h.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> LL Facility's Phone'. <br /> wo 18c.Signature of Alternate Facility(or Generator) <br /> !ZE Month Day Year <br /> Z <br /> Z <br /> 19.Hazardous Waste Report Management Method Codes(i.e,codes for hazardous waste treatment,disposal,and recycling systems) ' <br /> to 1' �i 2 3. 4. <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials vered by the manifest except as noted in Item 18a <br /> Pnnted/Typed Name Signature Month Day Year <br /> S7 G1 ,11ae <br /> EP��°IIYC$5'-3 f E Previous editions are obsolete. DESIGNA D FACILITY TO EPA's e-MANIFEST SYSTEM <br />