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SSL SK SHIP# 221702254 V 3��� IIIII�III (IIIIIIIIIIIIIIIIII I�II'll <br /> 0 0 5 9 4 7 9 2 6 S K S <br /> Please print or type.(Farm designed for use on elite(12-pitch)typewriter) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number TXROOOO81205 2.Paggt of 3.f-TNggy Reno —Phoee® 4.Manifest Tracking Number <br /> WASTE MANIFEST 11 11 G�O1100 46tl 1�b 1005947926 SKS <br /> S Generators Name and Mailing Address Generator's Site Address f different than mailing address) <br /> SAFETY—KLEEN SYSTEMS, INC. SAFETY—KEEN SYSTEMS, INC. <br /> PO BOX 555 5050 SALIDA BLVD <br /> SALIDA CA 95368 <br /> Generators Phone. 209-545-1011 SALIDA CA 95368 <br /> 6.Tgaspnrter 1 Companutff SYSTEMS, INC. U.S.EPA ID Number TXR000081205 <br /> 7.Trraannsspp'ort�erl2�'Comppaannyy NNaalm�e U.S.EPA ID Number <br /> 8.Designated Fal Name and Site Address SAFETY—KLEEN OF CALIFORNIA, INC. U.S.EPA ID Number <br /> 6880 SMITH AVE. <br /> NEWARK , CA 94560 <br /> CAD980887418 <br /> 510-795-4400 <br /> Facility's Phone. <br /> 9a 91h.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit <br /> HM and Packing Group(if air l) No Type Quantity Wt.Nol. 13.Waste Codes <br /> 1 NON—RCRA HAZARDOUS WASTE, LIQUID TT G 221 <br /> O (USED OIL) <br /> l <br /> W 2 <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional Information TSD:EVG SAL CSG: <br /> 24 HR EMERGENCY #1-800-468-1760 (SKI TFI) <br /> RUTH AS "AGENT—FOR" BY GEN TO RETAIN LICENSED SUB CARRIERS AS NECESSARY <br /> 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, <br /> marked and Iabeledlplacarded,and are in all respects 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 EPA Acknowledgment of Conse <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a) it I am a large quantity generator)or(b)(if I alillp sm. quantity generator)is two. <br /> General slORerors PrintedRyped Name Signature Month Day Year <br /> r z <br /> �J 16.International Shipments <br /> 1— ❑Import to U.S. ❑Export from U.S. of entry/exit: <br /> Transporter signature(for exports only): ate le ling LLS.: <br /> Ix 17.TransporterAdVowledgment of Receipt of Materials <br /> Transporter 1 Pnnd7Typed Name SignatureMonth Day Year <br /> O <br /> QTransporter Printedi Name Signature Month Day Year <br /> d' <br /> F <br /> I <br /> 18.Discrepancy <br /> l9a.Discrepancy Indication Space LlQuantity ❑T e <br /> yp ❑Residue ElPortia[RejeNon El Full Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> I Facility's Phone <br /> CS 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> 6 <br /> z <br /> y19.Hazardous Waste Report Management Method Codes(ia codes for hazardous waste treatment,disposal,and recycling systems) <br /> G 1. 2, 3, 4. <br /> 20.Designated Facility Owner or Operator.Certification of receipt of hazardous nnjenals covered by the manifest except as n4 in Item 18a <br /> Pirri if ed Name Signature Month Day Year <br /> g$ 2JerZ--e <br /> E55�� <br /> 1)11&0-256017 Pre editions are obsolete DES19VATED FACILITY TO DESTINATION STATE(IF REQUIRrEll <br />