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SSL SK SHIP* 'E, MUR4 <br /> Plaa'"es �, for-#pe.(form-a ned for use on elite 12- itch typewriter.) FormA roved.OMB No12050-0039 <br /> Y ( 9 ( 2-pitch) YP ) PP <br /> NIk ORM.HAZARDOUS '? Ge rator ID Number 2.Page 1 of 3.Eme enc Res onse Phone 1-4.,Manifest Tracking Number ;X <br /> WIlSTE MANIFEST, ;` <br /> ^118560" 19 FLE <br /> 5.Generators Name and Mailing Address Generator's Site Address(if different than mailing address) <br /> Golders Gats ADESA Golden Gate <br /> 1 West S$�.Ytford Rd Attn Samuel int henry 10501 Stanford Rd <br /> TIRA C6 95377 Attn Lester Sabo <br /> Generator's Phone: " 1+r#�' w% TRACY d;&1 953777-9708 <br /> 6.Trans orter 1 Com any ame U.S.EPA ID Number <br /> SAFETY-�tLEEN SYSTEMS INC <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8,Designated Facility Name and Site Addresss , U.S.EPA ID Number <br /> BAFET1 KL N 4F CALIFORNIA <br /> €450 SMITH AVE. <br /> NEWARK � CIS 94560 <br /> �1 �-75 ��4 � x CAU9� S� �1E( <br /> Facility's Phone: ; <br /> 9a, 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste,Codes , <br /> HM and Packing Group(if any)) <br /> No. Type Quantity Wt.Nol. <br /> 1.' NO -°RCRA HAZARDOUS WASTEv LIQUID ! TT C 221 ` <br /> (!USED OIL.) 39 <br /> z 2. <br /> w <br /> c� <br /> 3 <br /> 4. <br /> 14.Special Handling Instructions and Additional Information <br /> HR M RGENCYI-800-468-11760 ( H I SK � TFT) D <br /> to �, NEMBRARY <br /> 15. GENERATOR'S/OFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurat�n , <br /> ldescribed 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 intemational fiational governmental regulations.if export shipment and I am the Primary <br /> Exporter,l certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consg <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if 1 am a large quantity,generator)or(b)(if)rb a sm lf quantity generator)is true. <br /> Generator. eror's P6nted/Typed Nam. rgna ure /T Month Day F ear <br /> -r 16.International Shipments <br /> F— ❑Import to U.S. ❑Export from U.S. Port of entry/exit: <br /> Z <br /> Transporter signature for exports only): Date4eavin U.S.: <br /> W 17.TranspoderAcknowledgment of Receipt of Materials <br /> Tlanspoler 1 Printed ped tame gnature ont ay ear <br /> CL <br /> zTransporter ZPdnte0fryped Name Si nature month Day Year <br /> F- rT <br /> 18.Discrepancy <br /> 18a.Discrepancy indication Space quantity T e <br /> ,,, yp ❑Residue ❑Partial Rejection n Full Rejection <br /> Manifest Reference Number: <br /> 18b,Alternate Facility(or Generator) U.S.EPA ID Number <br /> if <br /> v <br /> Facilitys Phone: <br /> H18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> a <br /> Z <br /> 19.H zardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 1. 2. 3. 4. <br /> 20.Designated Facility Owner or Operator:Certifi tion of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Printed/Type pre Signature Month Day Year <br /> EPA Form 8700:22 Rev.3-05),'Previous editionware obsolete. DESIGNATED FACILITY TO GENERATOR <br /> f <br />