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y-l:Y^fATrOk -J I // y IIIIIIIIIIIIIIIIIIillll 1111111 11111 0 0 5 3 2 9 2 2 2 S K S Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 1.Generator ID Number 2.PagQ i of 3.Emeryency Response Phone. d.Man'rfest[Trackin N[u�mbern SKS UNIFORM HAZARDOUS '"P..00008120S On st 9 2 Vf\V WASTE MANIFEST 5.Generator's Name and Mailing Address Genemi Site Address(e different than mailing address) 5050 SALIDP "IT' SALIDA CA 95368_ Generators Phone: :=•tan—c.`�._„n j i SAL I DA - 6.TgrAspoper-1Company Name U.S.EPA ID Number 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address SAFETY—KLEEN OF CALT17ORNTAa U.S.EPA ID Number 6880 SMITH AVS- NEWARK CA 94560 1?I_7qF._t!,00 CAD9At718A.74?8 Faciliys Phone: Ra. 91h.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers, 11.Total 12,Unit 13.Waste Codes HM and Packing Group(If any)) No. Type Quantity WLNol, IX 1. 'RDQUS WASTE LIQUID T— o "_YCOL SOLUTIONa (LESS r, ;•= oa Z75 z 2. W 3. 4, 14,Special Handling Instructions and Additional Information rr; ' "ASK ' TFI) '�_TAIN LICENSED = 15. GENERATOR'S)OFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, marked and Iabeledlplawrded,and are in all respects in proper condition for transport according to applicable intemational and naficnal a ammental regulations.If export shipment and am the Primary Exporter,I cerdfy that me contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. I ceNfy that the waste minimization statement identified in 40 CFR 262.27(a)(ifl am a large quantity generator)or(b)(if I am mall entity generator)is true. Gene=s Pnnted/Typed Name Signature Month Day Year Z7 O 16.International ipments F El import to U.S. ❑Export horn U.S. fl,fentrylexit Transporter signature(for exports only): Was ving U. .: w 17.TrensporterAcknoWedgment of Receipt of Materials � Trans iter 1 Pnnled/Typed Name Signature Month Day Year IL G7 Al Q -Transporter2 PrintedyTyped Name Signature Month Day Year } 18.Discrepancy 18a.Discrepancy Indical on Space ❑ Quanfity ❑Type ❑Residue ❑Partial Rejection Full Rejection Manifest Reference Number: 18b.ARemate Facility(or Generator) U.S.EPA ID Number J U rQ+. Facilitys Phone: W 18c.Signature ofAtemate Facility(or Generator) Month Day Year Q z 19.Hazardous Waste Report Management Method Codes(Le.,codes for hazardous waste treatment,disposal,and recycling systems) 0 1. / � 1 2. 3. 4. 20,Designated Facility Omer or Operator Certification of receipt of hazardous materials covered by the manifest a as Rated in Item Ise PrillifTyped Name Signatu MoPth Day Y EPA Form 87c0rh0--22((RR"e^v.3-05) Previous editions amobsolete. DESIGNA FACILITYTO DESTIN4giONSTATIE/C(IFREQUIIRED)