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SSL SK SHIP# 214383310 <br />Please print or type (Fom1 designed for use on elite i12.Odd0 lyoewill <br />115/116 manifee),," y <br />i hitt <br />0 0 4 4 9 5 2 9 8 S K S <br />Fnrm Annm rl nUR Nn 911 n ogp <br />EPA Faro 8700.22 tRev 3.051 Previous adibons am obeolale. <br />1)11249/156017 <br />DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED) <br />UNIFORM HAZARDOUS 1. 3e asr ID Number <br />CAH111001044 <br />2. Page 1 of <br />1 <br />3 Emo nc R e Phone 4. <br />IfT90f�=117-760 <br />Manifest Tricking umber <br />WASTE MANIFEST <br />004495298 SKS <br />5. Genamtors Name end Malting Address Generelor6 SM Address (l different Nen mailing address) <br />San Joaquin County Public Works Solid Waste Div <br />7850 R A Bridgeford St <br />Stockton CA 95206-3939 <br />Generators Phone 559-972-7690 <br />'Tr T'Y-L E�! SYSTEMS, INC. UA EPA ID Number TXR0000B1205 <br />7. Transporter 2 Company Name U.S. EPA ID Nmrea <br />aDesg:1410dFeohlyName aMSoo Address SAFETY-KLEEN OF CALIFORNIA, INC. U.S. EPA Io Number <br />6880 SMITH AVE. <br />NEWARK , CA 94560 <br />510-795-4400 CAD980887418 <br />Fats$Phone, <br />ga. <br />9b. U S. DOT Desedpllon (lidding Pmpar Shipping Name. Habard Clare. 0 Number, <br />10. con is <br />11. Toler <br />12. Unit <br />HM <br />and Parking Grow (I wry)) <br />Duantiry <br />13. Wash Codes <br />WLNd, <br />No. <br />Type <br />o <br />NON-RCRA HAZARDOUS WASTE, LIQUID <br />TT <br />G 221 <br />(USED OIL) <br />°01 <br />� <br />SLO <br />2 <br />Z. <br />w <br />3 <br />SEP 04 2015 <br />4 <br />wad, <br />na <br />1.9pecul Handling lnstrudxaa and Ackkatsadmbrmalur TSD:EVG 65092747 SA33073 CSG: 60 <br />24 HR EMERGENCY #1-800-468-1760 (SAFETY-KLEEN) <br />15. CENERATOR'SIOFFEROR'S CERTIFICAnON: I hereby dedma thin the presnts ofthls consignmam are fey and accurately described above by the propershipphg name, mtlaredasNfied,pecaaged, <br />Thailad and labdewplacarded, and are in oft nespede n proper mmktion kr bansped accodingloapplirable atemadonaland national governmental regulalions Ifexpodshlpmentardlamtha Primary <br />Exporter, I cediy that the contents of this consignment conform to Tho tams of the attached EPAAdnowledgri l of Conse d. <br />1 wary run the waste hellenization shatementldenllned In40 CFR 262.27)a) (if I am a large quanMy, generator) of (b) ('dl am a small quantity Tomorrow) Is Inn. <br />Derrerdbattt74rtJ``s Po he"Typed Nerve Signers KarenDay Year <br />SM u.-tiC6Lu <br />.InkrtulsrW Is <br />LJ import to u.S. ❑Eopodfmm U.S. Ponofemryreea: <br />TrenspMwsgnamre lkreapaln Dory) Date leasing U S: <br />17 ranspwlw AckmwtedgmamofR"iotorMalerals <br />Travel Pnntedrryped Nage therefor i Month Day Year <br />�.'mer <br />Transitio8 <br />2 Pnmeariyped Name Slgnmum Ih Day Y r <br />a. <br />16 Diswapancy <br />Tea. Discrepancy Indirabon Space <br />OuenOly E) Type ❑Residue ❑PaNal Rejection ❑FNI0.ejer.Uon <br />Manifest Reference Numbel: <br />tae. Aaemme Facilly for Genembrl U.S EPA ID Nu ' <br />U <br />W <br />FaUblye Phone' <br />1&. Signature ofAl@mate Facility Tow Ciremlort Month Oay Year <br />Q <br />19. Hazardous Waste Report Management Method Code$ p.e., codes for harardous waste eealmenl, disposal, and recycling systems) <br />0 <br />1. <br />,S <br />2. 3 <br />4. <br />20. Designated Facility Owned or Opervor: Corurication ernicrept of hazardous materials covered by The modest excepts m <br />PnntM7fyped Na �a� 1' Sgnawro ' <br />e �� Day year <br />JC/ /o 1 if 4 <br />EPA Faro 8700.22 tRev 3.051 Previous adibons am obeolale. <br />1)11249/156017 <br />DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED) <br />