Laserfiche WebLink
SSL SK SHIP# 218089921 �l� (IIIIIIIIIIIIII�'ll'IIHIIII�IIIIIII) <br /> 005244922 SKS <br /> Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS I GemeaorlD Number CATOM13968 2.Pagt7 of d.Manilest Trackin Number <br /> WAST�EErMANIFESyT� gpa SAAyp� g�r��ay0 0 5 2 4 9 2 2 SKS <br /> s. t'�CAmttYS �EMS, INC. Generi��-tlYr—�1lL.tk.�tSYS I'tPlS�ss'I NC. <br /> PO BOX 555 5050 SALIDA BLVD <br /> SALIDA CR 9568 <br /> Generator's Plane: 209-545-1011 SALIDA CR 95368 <br /> 6 ,ICoWLr�ReSYSTEMS, INC. US.EPA ID Number TXROZOO81205 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Desgnal6!Faculty Name and Site Address SpIt-h I Y—KILLEN M URLIFILINNIH, INC. U.S.EPA ID Number <br /> 6880 SMITH AVE. <br /> NEWARK , CA 94560 <br /> 510-795-4400 CRD980887418 <br /> FacAkys Phone: <br /> ga gb.U.S.DOT desorption(intlWing Proper Stepping Name,Hazed Class.ID Number, 10.Containers <br /> 11.Tate) 12,Unit 13,WaEie Codes <br /> W and Packing Group 0f anY)) No. Type OuarNy VANa. <br /> — Hf4LAf(LKJLJbf <br /> LIIJIUID TT— <br /> (USED OIL) <br /> DO 1 Z <br /> w <br /> z 2 <br /> w <br /> CO <br /> 3 <br /> d. <br /> 14.Spical HarMeng Instructions and Additional Information C <br /> 24 HR EMERGENCY #1-800-468-1760 (SK / TFI) <br /> AUTH AS "AGENT—FOR" BY GEN TO RETAIN LICENSED SUB CARRIERS AS NECESSARY <br /> 15. GENERATOR'S10FFEROR'S CERTIFICATION: I hereby declare mal the contents of this consignment are fuly,W acbmately de rcwJ aboveby the proper Bill name,and are classified.packaged. <br /> marked and labelediplacaded.am are in all respects in proper condition for transport according o epi acahie intentional ala re-nal governmental regulaaons.M axpM shipment and I am the Primary <br /> Exporter,I ceNty that the contents of this consignment contain b the leans of the attached EPAAcknowtedgmalm of Consent. <br /> I zerbfy,that the waste minimization statement Mentified in 40 CFR 262.27(a)(8I am a large Quantity genamlor)or(bl lift am a all quality generator is cue <br /> Genera sORemfa PnmedrTyped Name Signature Month <br /> }} Daily Year <br /> J 1 rtA Shipments tin n b U.S. <br /> F ❑ pa ❑Export horn U.S. ary/exd: <br /> ent <br /> Z Transporter signature tfor exports only) Is leong U.S.' <br /> w 17.Transporter Acknowledgment of Receipt of Materials f <br /> Trans er i P19Iu:dTyped NameSgnatae Monty Cay Vear <br /> Po <br /> Zd Transporter Printeciftyped Nam Signature Month Day Year <br /> K <br /> H <br /> 18.Discrepancy j <br /> 16a.Diaaepzncy Indication Space ❑ Ouanoty ❑Type ❑Residua ❑Partial Rejection ❑FLA Rejection If <br /> i <br /> Manilest Reference Number. ' <br /> 1St.Alternate Facility(or Generate) U.S.EPA IO Number <br /> J <br /> U <br /> rat Faaliys Phare: <br /> Wtort.5igrawre ofMonnaie(mGty(or Generamr) Month pay Year <br /> a <br /> 2 <br /> N <br /> 19.Hazardous Waste Report Management Method Codes(i a.,codas fe hazardous waste treatment,disposal,and recycling systems) <br /> w ' C2. 3. d <br /> 7 <br /> 2C,Designated Facility O+ren or Opvatar CertAcetion of receipl of hazardous materials covered by the mantras a es Med in item 18a <br /> PrilleCyped Name SgnaN Mont, Day Year <br /> - ctc x -/F- r b <br /> EPPPhFgrgt91W,( f1 Previous editions aro obsolete. DEtIGNATE19FACILITY TO DESTINAT N STATE (IFR UIRED) <br />