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IP* 225735007 <br /> Please `�` type.(Form designed'for eon elite(12-pitch)typewriter.) Form Approved.OMB No.2050-003331 <br /> U (FORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3. mergenc Res onse Phone '"'4 Manifest Tracking Number C <br /> WASTE MANIFEST CAL 34875 1 ��i ® Ids01185605 FLE <br /> 5rGenerator's Name and Mailing Address Generator's Site Address(if different than mailing address) <br /> 41DESA GoAen Gate ADESA .® Golden Cate <br /> 15541 West St .>forid Rd Atto Saffliuel P+tchenry3 losel Stanford Rd <br /> TRACY :, CA 95377 Attrt Lester Sdbd <br /> Generator's Phone: 4 14-, 3 74 TRACY CA 95377-99708 <br /> 6.Transporter 1 Company "me U.S.EPA ID Number <br /> SiTtLSYSTEMS INC TXR000081POS <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Facility O Name and Site Address r U.S.EPA ID Number <br /> S EI` -KLEE t CALIFORNIA <br /> 6680 SMITH AVE® <br /> NEWARK G� CA 94 <br /> 9, 10-795-4-400 :. CAD980887418 <br /> Facility's Phone: <br /> ga. 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)) No. Type ;Quantity Wt./Vol. <br /> 1. WO -RCRA HAZARDOUS WAST v LI UTDTT S 221 <br /> o (LSD OIL) <br /> LU 2. <br /> w <br /> 3. <br /> 4. <br /> 14'Special Handling Instructions and Additional Information TSD,.- <br /> Sg EV A � CSS <br /> P4 HR EMERGENCY MERGENCY #I-BW-468-1760 (CH 1, SK TF <br /> BY BEN Tn RFTAIN JCIFN f3 9,11A rARRIAR AR e <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accu atel escribed 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 intemation a 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 C 1. <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)�am a small quantity generator)is true. <br /> Generator's eror's Printed/Typed Nameigna ure . L on ay Year <br /> S)A*j MOO <br /> 1 / <br /> 16,International Shipments - -� <br /> H ❑Import to U.S. ❑Export from U.S. Port of entry/exit: <br /> Trans orter si nature for exports only): Date leaving U.S.: <br /> W 17.Transporter Acknowledgment of Receipt of Materials -� - <br /> Tran rte 1 Printed/Typed Name S, I Month Day Year <br /> IL 7 <br /> U) <br /> Transporter 2 PrintedlTyped Name Signature Mont7 Day ear <br /> I-- <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑Type yp El Residue,, El Partial Rejection El Full Rejection <br /> Manifes.1 Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> LL Facilitys Phone: <br /> W 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> a <br /> z <br /> 55 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> G 1. r 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 /> Printedffyped NameSignature f Month Day Year <br /> ( <br /> EPA Form 8700-22 Rev.3-05)_Previous editions are obsolete. ` DESIGNATED FACILITY TO GENERATOR <br />