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JS L SK SI IP# 23 840335 (., r/1Oc-' Please print or type. 0 0 7 4 4 0 4 0 3 S K S Form Approved.OMB No.2050-0039 1 Generator ID Number 2. UNIFORM HAZARDOUS Page 1 of 19,186freFT'n. 4.Manifest Trackin Number WASTE MANIFEST TXR�Q10QIH1`'0 r 1 9 SKS SAFETY—KLEEN SYSTEMS, INC. 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) u nSAFETY—KLEEN SYSTEMS, INC. PO BOX 555 5050 SALIDA BLVD SALIDA CA 95368 Generators Phone: 209-545-1011 SAL I DA CA 95368 6.Trans orter 1 Com any Name U.S.EPA ID Number SI�FETY-{LEEN SYSTEMS INC TXR0000S1205 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address SAFETY—KLEEN OF CALIFORNIA U.S.EPA ID Number 6880 SMITH AVE. NEWARK , CA 94560 Facility's Phone: 510-795-4400 CAD980887418 9a 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit HM and Packing Group(f any)) No. Type Quantity Wt.N01. 13.Waste Codes 0 1. NON—RCRA HAZARDOUS WASTE, LIQUID 7T f 2`1 0 (USED OIL} Z 2. W 3. 4. 14.Special Handling Instructions and Additional Information TSD:EVG 5ALl CSG: 24H EMERGENCY#800-468-1760—CH/SK/TFI—Contract retained by generator confers agennenpratnrcy authori y On initiAll transpnrtpr to add Or substitute-15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this Consignment are fully and accurately described above by the proper shipping name,arca are classified,packaged, marked and labeled/placarded,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 Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Conse I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I smaigiantity generator)is true. Generator's/0 or's Pdnted/Typed Name Signature Month Day Year J 16.Intemational Shipments C�7 ZD Z ❑Import to U.S. ElExport from U.S. rt of entry/exit: Transporter signature(for exports only): ate leaving U W 17.Transporter Acknowledgment of Receipt of Materials Transporter 1 P' ed/Iyped Name Signature Month Day Year O r 07 CL 1Z7 1Ze:;P Z Transporter 2 PnntedffYP1&d Name Signature Month Day Year 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection 18b.Alternate Facility(or Generator) Manifest Reference Number: U.S.EPA ID Number J U u Facility's Phone: C3 18c.Signature ofAltemate Facility(or Generator) Month Day Year Q Z N19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) D 1 2. 3. 4. FDeed Facili Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted i Item 18a d Name !. Signature Month Day Year EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. 1) 11249/156017 E NATED FACILITY TO EPA's e'-MAINIFEST SYSTEM