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Sgt. SH all!P 22573 1 . <br /> Please,print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 <br /> [UNIFOg HAZARDOUS 1.Generator ID Number 2.Page 7 of 3.Emer ency Res onse Phone 4.MahifasfTracking Number ec ec <br /> W / EMANIFEST tp1.. 3St97 imt0gt - YCat� C7009 r�G <br /> '5 ener or's Name and Mailing Address Generatof s Site Address(if different than mailing address) <br /> ADESA - Golden Sate AAESA - Golden Gat <br /> 18501 West Stanford Rd Atty Samuel Mchenry 15591 Stanfard Rd <br /> y TRACY �� CA 95377 Atts Lester Saba <br /> Generators one: :"4-5374 TRACY CA 95377-9708 <br /> 6.Transporter 1 CompanyNome U.S.EPA ID Number <br /> S ET'Y—K M SYSTEMS INC TX000081205 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address ' U.S.EPA ID Number <br /> SAETY°�KImE � CALIFORNIA <br /> 6880 SMITH AVE_. <br /> NEWARK , CA 94550 <br /> 10-795-4400 CAD9 887 iS <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)) No.. Type Quantity Wt.NOL <br /> 1' D;fON -R RA HAZARDOUS WASTE, LIMA � TT � R, G 221 <br /> o (USED DID `'b <br /> z 2. <br /> W <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional Information TSP-.FVB A 195 CSG k <br /> €4 HR EMERGENCY #I-eft-468-1760 8-176 (CH SK 1' TEi) � <br /> AUTM AB to E — " AV C _N M RETAINs MF FSBARY <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 labeled/placarded,and are in all respects in proper condition for transport according to applicable intemationnd 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 EPAAcknowiedgment of C .111. <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or( fam a small qg4ntity gen ator)is true. <br /> Anted/Typed Na " re on ay YearGeneraOfferor P <br /> C' / *7119 <br /> 16:International <br /> Z Shipmehis ❑import to U.S. ❑Export JW_ <br /> ro S. Port of entry/exit: <br /> Transporter signature for exports only): Date leaving U.S.: <br /> Ce 17.TransporterAcknowiedgment of Recetptof Materials <br /> Tra rporter 1 Pntefype •Narod . _ gn t6re _ on ay Year, <br /> ir <br /> IL <br /> i, <br /> ZTransporter PrintedfTyped Name V Signature ME Day Year <br /> h ' <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space El Quantity El Type El Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> 186.Alternate Facility(or Generator)' U.S.EPA ID Number <br /> V <br /> LL- Facilitys Phone: <br /> UO 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> a <br /> Z <br /> ) 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 1: i; rf 2. 3. 4. <br /> f J; <br /> r <br /> 20.Designated Facility Owner orOperator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> s�. <br /> Printed/Typed Name Signature ; y Month Day Ygar <br /> t ) 1,7,, <br /> EP Form 8700-22 Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO GENERATOR <br />