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BWP SK SHIP# 234403238 <br /> Please print or type. 0 0 7 7 7 0 7 4 3 S K S <br /> 1.Generator ID Number Form Approved,DMB No.2050-0039 <br /> UNIFORM HA2ARDflUS 2.Pa T of 3.Em se 4.Manliest Tracking Number <br /> WASTE MANIFE5T T x �1 j ��� � r 1�0 o 7 7?a 7 s 3 SKS <br /> 5.Generator's Name and Mailing Address Generators Site Address{if drfferent than mailing address) <br /> PC SAFETY-555 SYSTEMS, INC. SAFETY-KL.EEN SYSTEMS, INC. <br /> SAL I DAx 555 50 5050 SAL I DA BLVD <br /> 9-545--1011 CA 95368Generators Phone: SRL I DA CA 95369 <br /> s.T � ltL V SYSTEMS INC U.S.EPA ID Number T R 8000081 X05 <br /> 7,Transporter 2 Company Name <br /> U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address SAFETY--HLEEN OF, CALIFORNIA <br /> U.S.EPA ID Number <br /> 6880 SMITH AVE. <br /> NEWARK ; CA 9456id <br /> CAD980887418 <br /> 510-795r-4400 <br /> Fapl' Phone: <br /> ga, 9b.U.S.DOT Description oduding Proper$ripping Name,Hazard Class,ID Number, 10.Containers <br /> HM and Packing Group(if any)) 11.Total 12.Unit 73.Waste Codes <br /> Na Type Quantity M.Nol. <br /> 1. NON-RCRA HAZARDOUS WASTE, L I GU I D TT G ��1 <br /> O (USED OILS <br /> Lu <br /> 2. <br /> .�D <br /> c� <br /> 3. <br /> 4, <br /> 14.Special Handling Instructions and Additional Information S V 194L <br /> CS7: if . <br /> 24H EMERGENCY#AW--468--17617--CHISK/TFI-Contract retained by generator confers a ency� authori y <br /> an initial tr or er o d r substitute additional transportes o er or' h f <br /> 15. GENERATpR'SIOFFERDR'SCERTIFICATION: !frereby decarethat the contents of this consignment are fully and accurately described above by The proper shipping name,and are classified,packaged, <br /> marked and labeledlpiacarded,and are h all respects in proper condition for transport a000rding to applicable intemabonal and national o mmental <br /> Exporter,I cethat the contents of this consignment conform to the terms of the attached EPAAcknowladgment Df Consen g regulations.If export shipment and I am the Primary <br /> rtify <br /> I certify that the waste ftnimization statement identified In 40 CFR 262.27(a)(if 1 am a large quantity generator)or(b)(if I smal lily generator)is true. <br /> GeneratorsIoEes'PO-i'nncte'�dlTyp erne Signature <br /> Month Day Year <br /> tfi.Interna conal Shipments <br /> ❑Import to U.S. ❑Export from U.S. of entrylexik <br /> Transporter signature(for exports onh): ate leavi U.S.: <br /> M 17.Trans Aclmowtedgment of Receipt of Materials <br /> Transporter PdntedlTyped Name Signature <br /> 1 Mwtlh 1}a]' Year <br /> aTranspc r 2 Printedffype erne Signature Month Day Year <br /> F <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space <br /> ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> 18b.RttemaO Facility(or Generator) Manifest Reference Number: <br /> U.S.EPA ID Number <br /> V <br /> Facility's Phone: <br /> JIM <br /> Uj 18c.Signature of Alternate Facility(Dr Generator] <br /> Q Month Day Year <br /> x <br /> H19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> YJ 1 <br /> H039 2. 3• 4. <br /> 211.Designated Facility Owner or Operator Ceocation of receipt of hazardous materials covered by the maxi t except as noted in Item 1 Ba <br /> Nn Name Sig <br /> Day Year <br /> EP+ ��ffififti117 Previous editions are obsolete. DE5 GNATED FACILITY TO EPA's e-MANIFEST SYSTEM <br />