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SSL SK SHIPIIW� � <br /> 0 , <br /> Please print or type.(Form designed for use on elite(12-pitch)typewriter) <br /> UNIFORM HAZARDOUS 1.Generator ID Number CA(.00035283L 2 pag11 of form Approved.OMB No.2050-0039 <br /> 3j �fY. g1S2 4.Mantkst Tracking Number <br /> Nam <br /> GWaASTcEy'MANIFEapStlT ng 15523762 ��� <br /> 5 l]BfLIT1 er !PUCK lips/Class Sales IT Generators Site Address(iftlifferent than mailing address) <br /> 2577 W YOsevite Ave <br /> MANTECA CA 95337-9641 <br /> Generators Phone: 765-690-0109 <br /> 6 "NEFER"SYSTEMS, INC. U.s:EPAIDNumber TXRO@0081205 <br /> 7.Transporter 2 Company Name <br /> 0.S.EPAID Number <br /> 8.Designated Facility Name and Site Address IFFIRM Ir !IT <br /> 1737EAST DENNI STREET us.EPAlo Namber <br /> k 310-635-9998 WILMINGTON , CA 90744 <br /> Facility's Phone: CAD@44429835 <br /> ga. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers <br /> HM and Packing Group(if any)) 11.Total 12.Unit ria.Waste Codes <br /> 1. No. Type Quantity VILIVOI. <br /> o (OIL FILTERS) ' DM 223 <br /> Z 3 <br /> W 2. �iSo <br /> C7 <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions antlAdtlitional Information 1 6 565 <br /> CSM. <br /> 24 HREMERGENCY 1F1-800-468-1760 (SK ! TFI) �� � 'f-! - 1 <br /> AUTH AS nAGENT—F0R" BY GEN TO RETAIN LICENSED SUB CARRIERS AS NECESSARY <br /> 15. GENERATORB/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, <br /> marked and Iabelec/placarded,and are in all respeds in proper condition for transport according to applicable international and national governmental regulations.If export shipment and I am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent <br /> I codify that the waste minimization statement identified in 40 CFR 262.27(a)if I am a large quantity generator orb if I am a small quantity <br /> Generators/ORemes Pnnted/T ) I)( q ry generator)is true. <br /> ypetl Name Signature Month Day Year <br /> n kVute2 <br /> 16.Inter nal Sl w <br /> F" ❑I port to U.S. ❑Export froU.S. Port of ntry/exit: <br /> Trenspbner signature((..exports only): <br /> Date leavin .5.: <br /> W 17.Transporter or Receipt of Materials <br /> Tr orter 1 Primeypeo Na <br /> a (\r } Month Day Year <br /> ¢ Transporter 2 Pnnted/Typed Name <br /> f— afore .nth 1 <br /> Diy Year <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑ <br /> Type ❑Residue EJ Partial Rejection ❑Full Rejection <br /> 181b.Alternate Faulty(or Generator) Manifest Reference Number <br /> —r U.S.EPA ID Number <br /> U <br /> LL Fadlitys Phone: <br /> W 18c.Signature of Alternate Facility(..Generator) <br /> Month Day Year <br /> co <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> C 1 q 2. 3. <br /> 4. <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hammous matenals covered by the manifest except as nded in Item 18a <br /> PnntedlTypad Name C 14l :;+, Signature <br /> 1 9 � V M th Day Year <br /> EPAFgrpl 4&-J2.1Rer,J6f 7p,rpv✓ious editions are obsolete. �"- <br /> lr tbl FSS�ldb/ DESIGNATED FACILITY TO GENERATOR <br />