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SK SHIP# 218496864 111111111111111111111111111111111111 005259616SKS Please print or type.(Farm designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page t of 3.Emergency Response Phone 4.Manifest Trkin4 Number (� WASTE MANIFEST r';.;iZ 14=r 1005'2' J 9616 S K17 5,Generators Name and Mailing Address Generator's Site Address(if different than mailing address) =n Joag-tin County H..HW Facility 7850 RA Sridngeford St '�TOCKTCIN _ CA 952415-000 Generators Phoney -'—y}�8—„�,rQ 6.Transporter i Company Name U.S.EPA ID Number STEMS, INC. 7.Transperter 2 Company Name U.S.EPA ID Number 6.Designated Facility Name and Site Address U.S.EPA ID Number SAFETY-KLEEN OF CAI_IFORhJIA, Ih!C. ill SMITH AVE, NEWARK , CA 94560 Facility's Phone: 510-795--4400 CAIS"80887418 ga 9b.U.S.DOT Descdptlon(including Proper5hipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13,Waste Codes HM and Packing Group(if any)) No Type Quantity Wt.Nol. o N RCRA NA7_ARDOJS WASTE,LIQUID 7 7-1-1 LU Z 2. W (.7 3. 4. 14.Special Handling Instructions and Additional Informaton TS©:EVG C-0103945 24 HR EMERGENCY 41--500-468-17F-0 (GK T'FI) _ n.11 � gre� porspp1N & e5.-G f0 TFCDfireclarheoingname,and are classified,packaged , marked and labeled0acarded.and are in all respects in proper condition for transport according to applicable international and rational governmental regulations.lf 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 Consent. - I certify that the waste minimization statement identfad in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(81 am a small quantity generator)is true. Generatol,1111erol,Printedlfyped ams l/ Signature - Month Day Yp r nit I ie. ao • 5 1 16,Interna iona birtipments Ll Import to U.S. ❑Export from U.S. Portof entrylexit - Transporter signature(for exports only): Date leaving U.S.: ,a 17.TransporterAcknawledgment of Receipt of Matedals O Transports 1 Pnntedffyped Name Signature Month Day Year QTra prier not /Typed Name _ Signature Month Day Year Fes— >j VF 18. iscrepancy 18a.Discrepancy Indication Space ❑Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number J U LL Facility's Phone W 18c.Signature ofAltemate Facility(or Generator) Month Day Year Q Z A19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) p 1 �� J/ 2. 3. 4. 20.Designated Facidii Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 1 Be PnntedlTyped Name. Signature Month Day Year EPA Form 8700-22(Rev.3-05)Previous editions are obsolete. DESIGNAT FA L1TYTO DESTINATION STATE IF REQUI ED) 1 J 551!1_`:603✓it