Laserfiche WebLink
SK SH I P'S 227705003 ti <br /> PI>ase pr'int,ortype, form Approved.OMB No.2050-0039 <br /> UNIFt�RM HAZARDOUS 1.Generator ID Number 2:Page 1 of 3. m R s e P 4.Manifest Tracking Number <br /> n CAL00�-346875 -1 �- �' iI'9fSKS <br /> STE,MANIFEST00695-2643 <br /> . r; <br /> .Generatges'Name and Mailin Address Generator's Site Address(if different than mailingaddress) <br /> ADESA — �Saldjew Gate AD?ESA - Holden Cae <br /> '' 18501 best At ford Rd Attn Samuel Mchenr•y 18501 Stanford Rd <br /> TRACY CA 95377 Attn nester Sabo <br /> Generators Phone: TRACY CA 5177-9708 <br /> 6 Tr o <br /> U.S.EPA ID Number <br /> SYSTEMS INC TXR@00081205 <br /> 7.Transporter2 Company Name U.S.EPA ID Number' <br /> t3.Designated Facility Name and Site AddressSAFETY.-KLEM OF CALIFORNIA U.S.EPA ID Number <br /> 6880. SMITH AVE. <br /> NEWARK , CA 94560 <br /> 51077 -4400-°440 CAD98088741�3 <br /> f6cllitys Phone: <br /> ga. 9b:U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit <br /> 13.Waste Codes <br /> HM and Packing Group(if any)) No. Type Quantity Wt.Nol. <br /> 0 1. N00- RCOICHAZARDOUS WASTE, LIQUID TT G 221 <br /> ®.a <br /> z to <br /> 2. <br /> LU <br /> C9 ; <br /> 3: <br /> 4: <br /> 14.Special Handling Instructions and Additional Information e ® 7,9, 6763 f�It2019e �S�$ _ <br /> --- <br /> P-4H EMERSENCY#800=-468-1760-CH/SK/TFI-Contract retained by :generator confers agency authority <br /> on initial trans orter.-to.add or substitute additional transporters an generator's behalf. <br /> 15.,GENERATOR'SIOFFEROR'S CERTIFICATION:1 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 labeledlplacarded,and are in all respects in proper condition for transport according to applicable international and national governmentaliregulations.If export shipment and I am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the ter mslof.the attached EPAAcknowledgment of Consent. <br /> I,certify Qiat the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator).orib)(if I am a small quantity generator)is true. <br /> Generator Offerors Printed/Typed Name Signature Month Day Ye <br /> J 16.International ShlOnlents <br /> F— ❑Import to U.S. ❑Export from U.S. Port of entry/exit: <br /> z Transporter signature(for exports only): Date leaving U.S.: <br /> w 17.TransporterAcknowledgMent of Receipt of Materials <br /> Transporter nnted/Typetl Name a Signature Month Day Year <br /> IL <br /> Z Transporter 2 Printed/Typed Name Signature Month" bay Y ar <br /> 18.Discrepancy ► <br /> 18a.Discrepancy Indication Space Quantity ❑Type ❑Partial Re j <br /> Residue Rejection El Re ection <br /> Manifesi Reference Number: <br /> 18b.Alternate Facility(or Generator) r U.S:EPA ID Number <br /> J <br /> Facilitys Phone: <br /> w 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> Z <br /> 55 197Hazardous Waste Report Management Method Codes(i.e.,codes for hazardouswaste treatment,disposal,and recycling systems)LU <br /> ' <br /> 1.. 2. 3 4. <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazar ous materials covered by the manifest except as noted in Item 1Ba <br /> Pnntedffyped ame 'Signature Month Day Year <br /> mLrk' :1 n I I <br /> EPA Fc e 0-22((R v.12-�Z) Previous editions are obsolete: DESIGNATED FACILITY TO GENERATQR <br /> 13 {` 9/156 17 <br />