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SSL SK SHIP# 214773375 <br />Please print or type. (Forel designed for use on elite (12-pkh) typewriter.) <br />115/116 manifest V 111 111111111111111111111111111111111111 <br />0 0 4 6 1 2 3 6 2 S K S <br />ForrynApproved. OMB No. 2050-0039 <br />EPA Form 8700.22 (Rev. 3-051 Prgeious BMWs are obsoiele. <br />1)651/156030 <br />Ut51U1NAl ED I-ACILlrs Over,arr n..,,v,. <br />STATE 1.. ..�.. <br />UNIFORM HAZARDOUS t. GeM4dof ID Number <br />2.Paplol <br />3.Emeryency Response Phona <br />1-800-4Afi-1760 <br />e. Mandest Tracking Number <br />G SKS <br />WASTE MANIFEST CAHIIIO01044 <br />1 <br />S. CanomWri Nemo and Melling Andreae Gsneraloea SkeAddmo (f different Nan maging address)) <br />San Joaqquin County Public Works Solid Waste Div <br />7850 R A Bridgeford St <br />Stockton CA 95206-3939 <br />Genemwes Phone: S59-972-7690 <br />B. Tsangglyr l Company RIM U.S. EPA ID Number TXR000091205 <br />SAFETY-KLEESYSTEMS, SYSTEMS, INC. <br />T. TampoMr Z CaMeny Name U.S. EPA ID Number <br />9 Desgnaled FidMy Name and ShaAddrga SAFETY-KLEEN OF CALIFORNIA, INC. U.S. EPA ID Number <br />6880 SMITH AVE. <br />NEWARK CA 94560 <br />510-795-4400 CAD980887418 <br />FapY'e Prone: <br />ea. <br />go US DOT Deselptlm (induding Proper Shlpphg Name. Heats Class. ID Number, <br />10. Comalnars <br />11. TOW <br />12. UM <br />18. V&bCodes <br />Na. <br />Type <br />HM <br />end FKWng Gnsup(lry)) <br />Qmtfty <br />WIAbI. <br />g <br />t"NON RCRA HAZARDOUS UASTE, L10UI0(d>L <br />T'T <br />G <br />;zu <br />w <br />2E <br />CAN z.1. <br />a <br />E TAL <br />NCO <br />AA NIT <br />14. HrldmglydhKeasandAAdeoulorlon Vp TSD: EVG 65512209 SA33073 201451 CSG:60 <br />24 HR EMERGENCY H R00-468-176O(SAFETY-KLEEN - 94138) <br />r <br />15 GENERATOR'StOFFEROR'SCF.RTIFICATIGN:IMrobydecian Out boomisMsolNkaunlplm &are NAyanda ramydMniaedebovebylMproWBNPpe9oame.oMemc 9M'" MckagW, <br />marked and Mbelad0searded, and are In ag respells In propermMebn for nnspat acmrd'ag n applimble'nkmetionaland Mlional govemmenlal m"uryns. if expon shipment and I am the Primary <br />Expaler, I coney mat tla conlenw of Ws consignment mMam to as lelina Mine starched EPAAdMwbdgmml MCmMnt <br />I cedify sal Ma wasto Mniniaun sMlemenl identified 6140 CFR 26Z2T(a) (if I sen a tare nasality generator) a (b) (I1I am a small auanary geMrala) a he <br />GenemtoesJOYaa/s PrinkM!TyPad Name SgnaaOe - _ kbnlh Day Year <br />15110 <br />'61 <br />J <br />16 Immiaml Shower <br />❑Impodto U.S. rlEspol bort, U.S. PaAdenaylexil'. _ <br />larnaponer 117WIL,a At exports My : Dale teaOrm u.S.. <br />17. nanspannAcknow"mam of Remiptaf Melrisla <br />K <br />Day Year a, t PnnledTyped Name SIgMMm MMIh <br />a <br />C� .wr r y �r <br />Z <br />Tmnsymlar 2 PMlodfyyped Name 519^ M0011, Day Year <br />Q <br />19 Dlsaepanry, <br />1 <br />lea. Oiser"ancy Indatlon Spam ❑ Oaaaay ❑ Type ❑ Ra ua ❑ PrIW R.Ontion �_ Fug Rejecter, <br />Mendes: Ralarercm Nanha' <br />190 Merge Facility (or Generator) US. EPA ID Numbv <br />V <br />W <br />Family's PMra: <br />Faceity CenamtorJ Month Day Year <br />lar. Signelum of AMewto la <br />19 NaaMme Waste Repro Management Method Codes g e., moire for hazardous waste bealmenl, disposal, and mcydiwayslems) <br />� <br />1 <br />1 3. <br />A. <br />no <br />20 . DngMIW Fedlsy Ormerar Opamlor. Cadfimtlon of mmiplal Mamous meariale mrarm by me nanllesl extepl air ants In Mm 18e <br />1 <br />SI pare Munro wy Yeaarrr <br />Prinad ypW emir g �• <br />I.7 <br />�� <br />wwTrnAl STATE ten mCn111OFn <br />EPA Form 8700.22 (Rev. 3-051 Prgeious BMWs are obsoiele. <br />1)651/156030 <br />Ut51U1NAl ED I-ACILlrs Over,arr n..,,v,. <br />STATE 1.. ..�.. <br />