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BSL. 59, SHIP# 't�.g�"OD'. <br /> Form roved.OMB No.2050-0039 <br /> Please printer type.(Form deshpned forllse on elite(12-pitch)typewrites.) R�soor,sep APP <br /> UNIFORM HAZARDOUS I-Genemor10Number' (�Atii9132 97828 2.Pagel of 3.Er c��!s?, V.� 4.MardtedireekingNumber <br /> WASTE MANIFEST Y d 05759906 SKS <br /> 5.Generators Name and Mailing AddressIf. -- eMeneralars SneAddress[ddifferent than mailing address)) <br /> Cal Tram Shop 10 Gids <br /> 2045 Krohn Rd <br /> TRACY CA 9S77-Y 12V <br /> Generators Phone: <br /> op�an2'0�9pa-835-fit 779 <br /> -.SYrSTEMS,- INC, U.S.EPA ID Number 'i XROOQCo8 .. <br /> 7.Transporter 2 Company Na - U.S.EPA ID Number <br /> Nam <br /> 8.Designated Facility Name and Site Address THERMO FLUrp$ Imc U.S.EPA ID Number <br /> 4341 U JEFFERSON ST <br /> PHOENIX AZ G5043 <br /> Facilky's Phone: .. - <br /> 9a. 9b.U.S.DDT Descnption(induding Proper Shipping Name,Hazard Class,ID Number, 10.Containers it.Tow 12.Unit 13.Waste Codes <br /> HM and Packing Group(d any)) No. Type Quantity WLNol. <br /> 1.NON-RCRA HAZARDOUS WASTE, SOLIO - [)F3 f2213 <br /> fORAINED/UNORAINED USED OIL. FILTERS) � 90 - <br /> w V <br /> 4 <br /> i <br /> 14.SpedalHandling lnstructonsandAdditionallnformation :TPA ?213709S-3 CAr477S4 2017; 50-?4 <br /> 24 HR EMERGENCY #1'}800-466-1760 (3K ! Ti=I! 1 �( <br /> AUTH A5 "AGEMT-FOR" BY GEN TO RETAIN LICENSED 8011 CARRTER't :6(4 6C-eRY' <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION:I hereby dedam that the contents of this consignment are fully and accurately described above by the proper shipping name,and are daseified,Packaged, <br /> marked and labeledipmcarded,and are in all respects in proper condition for transport according to applicable international and nal fgovernmental regulations.N export shipmerd and I am the Primary <br /> Exporter,I certify that the owl"of this consignment conform to the terms of the attached EPAAckrwwledgmentof Consent. <br /> I cer8fy that the waste minimization statement identified in 40 CFR 262.27(a)('d I am a large quantity generator)or(b)('dl am a smalk quantity generator)is rrra. - <br /> Genermorr'slOfferoalixintATypedName Signature, Month Day Year <br /> —A 16.Intemational SMpmerts <br /> h ❑Import to U.S. ❑Export from U.S. Portof entrylexd: <br /> Z Transporter signature(for exports only):. Date leaving U.S.:. <br /> 17.Transpoder Acknowledgment of Reoelpt of Materials <br /> W Transporter 1 Printellyped Name - Signature Month Day Year <br /> l' tl.Ilkf-j . -., v l 33 1 t <br /> _a Transporter 2 Printew typed Name - - - Signature Month Day Year <br /> K <br /> r <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number. <br /> t 18b.Alternate Facility(or Generate - U.S.EPA ID Number <br /> J <br /> LL Facilays Pnone: <br /> �4 W 18c.SignaWre ofAgemate Facility(or Generator) - - Month Day Year <br /> I Q <br /> z <br /> y19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) - <br /> 20.Designated Facility Owner or Operator.Certification of receipt of hazardous materials covered by the manifest exoept as noted in kerkl8a - <br /> Printedffyiped Name �� Signature Month Day Year <br /> 1 11G <br /> Ef Ft�gFt2.( viousedi'onsareobsolete. DESIGNATED FACILITY'S COPY <br /> lt5f�6Jk!1���� <br /> i - . <br />