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SSL SK SHIP# CC-18730661 <br /> 005328350 S KS <br /> Please plant or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2051 <br /> UNIFORM HAZARDOUS <br /> t.GeneTXR000081205 2 Pati9 1raw M Number !of 3 E �'" �` 4.Manifest Tracking Number <br /> - <br /> 1005328350WASTE MANIFEST SKS <br /> Generotces S'le Address d diXerent dtan maili adtlressl <br /> S nFSr tfy1_ "N STEMS, INC. SAFETY—KEEN SYSTEMS, INC. <br /> PO BOX 555 5050 SAL.IDA BLVD <br /> SALIDA CA 95368 <br /> Cor torsPhae 209-545-1011 SRLIDR CR 95368 <br /> V fft'ft a SYSTEMS, INC. us.EPAIDNumbe <br /> 6 TS TXR000081205 <br /> 7 Transporter 2 Company Name U.S.EPA ID Number <br /> 8DesgnatmFacility Name amSite Address SAFETY—KLEEN OF CALIFORNIA, INC. us EPA ID Number <br /> 6880 SMITH AVE. <br /> NEWARK , CA 94560 <br /> 510-795-4400 CRD980887418 <br /> F 's Pnane. <br /> ga. 9b.US DOT Desorption(Including Proper Supping Name.Hazard Class,ID Number, 10.Conlainers 11.Total Q.Unit 13.It/4sa Codes <br /> HM am PaGung Grap(dany)I No. Type OuantM VANN. <br /> NON—RCRA HAZARDOUS WASTE, LIQUID TT G 221 <br /> o (USED OIL) <br /> GCS L <br /> z z <br /> W <br /> 3. <br /> 4. <br /> x <br /> 14.Speaal Handling instructions and Addrbonal Information TSD:EVG SAL CSG: t <br /> 24 HR"EMERGENCY #1-800-468-1760 (SK 1 TFI) <br /> AUTH AS "AGENT—FOR" BY GEN TO RETAIN LICENSED SUB CARRIERS AS NECESSARY <br /> 15. GENERATORWOFFEROR'S CERTIFICATION:I hereby declare mat the comems of this mrspnmenl are WIIy and accurately described above by the proper snipping name,and are classified.pa Caged, <br /> marked and abeledpacaNm,and are in all respects in proper condition M transpot accordng to applicable international and national gm amore is regulations.If wow shpment and I am he Primary <br /> Exporter.i comfy that the coments of dtls consgnmam mnlorm w the terms of the attached EPAA knDwlk gme Can 1. <br /> I certify sat me waste mmimi Wn statement identified in 40 CFR 262.27(a)(X I am a large quantity generota) (bl lel m a vnaY qua+ely generota)Is true. <br /> Gement 'v Off hi PmeedRMonthyped Name Signaw Month Day Year <br /> 1 al hipmente <br /> f— ❑..mWn w U.S ❑Export him US Pat of aptrylotit <br /> Transporter s�gnawre jor imports alp'. Date U.S.. <br /> G: 17.Transporter Acknaiiiedgmere of Receipt of Materials Monty Day Year <br /> Tans 1 PdntedRyped Nana SignaWre <br /> 00 !! / <br /> Trencporler tedrryped Nana Sgnawre MmM OaY Year <br /> 1 18.Discrepancy <br /> l08.Cixrepan y Imicatldn Space ❑ Quamrty ❑Type ❑Residue ❑Partial Rejection ❑Ful Relw'In+ <br /> Manifest Retoence Number <br /> 18b.Aitemale Faaliry(dr Genealor) U.S.EPA ID Number <br /> U <br /> Faoetys Plwne. <br /> w 18c. IgraWra of Aleernate FxaM la Gemeesal MO'IN Day Vear <br /> Q <br /> 2 <br /> y1S.Harardpus este Report Management Method Codes(i.e..meas tar haramous waste treatment disposal,and recycling systems) <br /> C 2 3 <br /> 1 1 <br /> 20.D4ignatm(F�acility 0"a Oparmor.CeMratwn of 25!pt of hazardous marshals covered by the manias! U in Nem 1 <br /> Prim a ignaum w <br /> s-.✓ <br /> E 1)11249/1.017 revicus editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REOUIRED) <br />