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SSL SK SHIP# 224220484 ey//l", 1111111111111111 IIIIIIIIIIIIIIIII111 <br /> Please print 0 0 6 3 2 5 0 9 8 s K st or type.(Farm designed for use on elite(12-pitch)typewriter.) Form Approved,OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number TXROOOO812O5 2.Pay 1 of 3,Ert)@ryr,Uiry BESfa7nselP�pp� d.Manifest Ira in Ny�b <br /> WASTE MANIFEST 1 1 tl1010 4btl /6 O O 6 1 1.,6 9 Q SKS <br /> S.Generator's Name and Mailing Address Generetols Site Address(Ememm than mailing address) �J JO <br /> SAFETY-KLEEN SYSTEMS, INC. SAFETY-KLEEN SYSTEMS, INC. <br /> PO BOX 555 5050 SALIDA BLVD <br /> SALIDA CA 95368 <br /> Gonerators Phone: 209-545-1011 SALIDA CA 95368 <br /> B.ftYcgR ff&eSYSTEMS INC U.S.EPA ID Number <br /> TXROOOO812O5 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address SAFETY-KLEEN OF CALIFORNIA U.S.EPA ID Number <br /> 6880 SMITH AVE. <br /> NEWARK , CA 94560 <br /> CAD98O887418 <br /> 510-795-4400 <br /> Facility's Phone: <br /> ga. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers11.Total 12.Una <br /> HM and Packing Group(it any)) No. Type Quantity Wtive. 13.Waste Codes <br /> ' NON-RCRA HAZARDOUS WASTE, LIQUID TT G 221 <br /> o (USED OIL) <br /> xx> 3I9 <br /> Z 2. <br /> W <br /> U <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional Information TSD:EVG SAL CSG: , <br /> 24 HR EMERGENCY #1-800-468-1760 (SK / TFI) <br /> RUTH AS "AGENT-FOR" BY GEN TO RETAIN LICENSED SUB CARRIERS AS NECESSARY <br /> 15. GENERATOR'SIOFFEROR'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 labeled/placarded,and are in all respects in proper condition for transport according to applicable international and national g vemmental 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 Consent. <br /> I certify that the waste minimization statement identified in 40 CFR 282.27(a)(8I am a large quantity generator)or(b)(if I am a smalli.nto generator)is true. <br /> Geneni emrs PrintedlTyped,Uame Signature Month Day Year <br /> J <br /> 167firternational Shipments <br /> F ❑Impart to U.S. ❑Export fiom U.S. Po trylexit: <br /> = <br /> Transporter signature for exports only):W 9 ( W y): D avmg U.S.: <br /> W 17.Transporter Acknowledgment of Receipt of Materials <br /> tE7rensporter 1 n edlTyped Name Signature Month Day Year <br /> O r <br /> N oL Zo 8 <br /> Q Transporter PnntetlRyped Name Signature Month Day Year <br /> K <br /> r <br /> i18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ puanti <br /> ly ❑Type ❑Residue ❑Partial Rejection El Full Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Faality(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> LL Faalitys Phone: <br /> w 18c.Signature ofAltemate Faality(or Generator) Month Day Year <br /> Q <br /> Z <br /> H19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> p 1. 0 2. 3, 4. <br /> 20.Designated Facility Owner or Operator.Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> PdntedlT Name Signature Month Day Year <br /> k..al.. <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br /> 1) 11249/156017 <br />