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SSL SH SHIP# 226644979 <br /> Please print or type. Form <br /> Approved,OMB No.2050-0035 <br /> UNIFORM HAZARDOUS 1.Generator ID Number TXR000081205 '.Pagel of 3.€m R eMenaO 4.1fianifest TrecId Number <br /> WASTE MANIFEST 11 �r OO 006716120 SKS <br /> S.G me d A Genera r ress d d' t n m 8i dress) <br /> p u — MTEMS, INC. —�L. (l V� INNS INC. <br /> PO BOX 555 5050 SALIDA BLVD ' <br /> SALIDA CA 95368 <br /> Generators Phone. 209-545--1011 SALIDA CA 95.368 <br /> 6T%WMf9Q�& SYSTEMS INC U.S.EPA ID Number TXROSO081205 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address 9AFE'TY—KLEEN OF CALIFORNIA U.S.EPA ID Number <br /> 6880 SMITH AVE. <br /> NEWARK , CA 94560 <br /> 510-795-4400 CAD980887418 <br />• Facility's Phone: <br /> gra go.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 OuanMy Wt.NoL 13.Waste Codes <br /> 1. NON—RCRA HAZARDOUS WASTE LIQUID TT G 221 <br /> o (USED OIL) ' <br /> z 2. <br /> W <br /> 3. <br /> 4, <br /> 14.Special Handling lnstmceons and Additional Information TSD:EVG SAL CSG: <br /> 24H EMERGENCY#800-468-1760—CH/SK/TFI—Contract retained by generator confers aggency authori v <br /> on initial transporter to add or substitute additional trans orters on enerator' s behalf. <br /> 15. OENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the currents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, <br /> marked and Iabeledlplacarded,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 carry 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 quantlty generator)or(b)(if I am a sural quantlty generator)is We. <br /> Generatots/Ofi rs Primed7Typed Name Sgnature i Month Day Year <br /> t <br /> 16.International hipmenls <br /> F ❑import to U.S. ❑Export from U.S. Porl entrylexit: <br /> = Transporter signature(for exports only) Owl leaving U,S.: <br /> C 17,Transporter Acknowledgment of Receipt of Materials <br /> W <br /> = Iransporte 1Pnntedrryyed Neme Signature Month Day Year <br /> a i <br /> QTransporter 2 Pnntedrryped Name Signature Month Day Year <br /> H <br /> 1 18.Discrepancy <br /> I 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑p utud Rejection ❑Full Rejector <br /> Manifest Reference Number: <br /> 18b.Animals Faclity(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> LL Facility's Phone' <br /> W 18c.Signature of Alternate Faallty(or Generator) Month Day Year <br /> Q <br /> z <br /> N19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 0 1. 2. 3. 4. <br /> �L � <br /> 20.Designated Facility Owner or Operator:CerVication of receipt of hazardous materials covered by the manifest except as noted in Item las <br /> PrintedlTyped Name /- Signature Month Day Year <br /> wL -, <br /> EPA 5cfjgj94�(ILeg,12;4) Previous editions are obsolete. � DESIGNATED FACILITY COPY <br /> 1 WOWED F��`�1VED THIS MANIFEST,YOU HAVE RESPONSIBILITIES UNDER THE e-MANIFEST ACT.SEE INSTRUCTIONS ON REVERSE SIDE. <br />