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SOL SK SHIP# 2257335014 <br /> Please prin type.(Form designed for use on elite,12-pitch)type rite.) Form Approved.OMB No.2050-0039 <br /> U ORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3. me R s e P p 4 Man aifest Trackin Number <br /> FLE <br /> 1 MSTE MANIFEST , <br /> 5.Generator's Name and Mailing Address Generators Site Address(if different than mailing address) <br /> +ADESA - Golden Date AD — Golden Pate <br /> IS561 West Stanford ltd Attn Samuel Kchenry 18501 Stanford Rd <br /> TRACY v CA 9537'7 Atto Lester Saba <br /> Generators Phone: —r.,3 TRAGI CA X 537'?--5708 <br /> 6.Tr ns oiler 1 Com any Neme U.S.EPA ID Number 1Qr <br /> 900Y- �E A SYSTEMS INC <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address SAFETY�KLEEN CR CAS I i Rel I U.S.EPA ID Number <br /> 6880 SMITH AVE. <br /> 510-795-44 W RK CA 0,4566 <br /> 6�1 CAL� SS67�16 <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 /> r. NON-RCRA 14AZARDDIJS WASTE, LIQUID 00 1 TT a baa <br /> 0 (USED OIL) <br /> Z 12. <br /> LU <br /> CD <br /> {q <br /> 3. <br /> r <br /> 4: a <br /> T+ <br /> 14,Special Handling Instructions and Additional Information <br /> 4 HP E 6 Y1-600 °465-17'6 .(CH � SK � TFY) <br /> AUTH A ,, -E r� T N LICENSED INECESSARY <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the oontents,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 international and 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 Consent. <br /> 1 certify that the waste minimization statement identified in 40 CFR 262.27(a)(if 1 am a large quantity generator)or(b)(if I am a small quantity generator)is true. <br /> Generators/O ernes Printed/Typed Name Signa ure on _ay ear <br /> /� f IP <br /> -j <br /> 16.international Shipme is <br /> F— ❑Import to U.S. ❑Export from U.SI Port of entry/exit: <br /> Z Trans rter signature for exports only): Date leavin U.S.: <br /> rY 17.TransporterAckriowledgment of Receipt of Materials f <br /> Transp rier 1 PrinfedlTyped me, '2 ig re Montay ear <br /> a "' % '� <br /> u> <br /> Month Da ear... <br /> zTransporter 2;Prin edrryped Name Signature Y <br /> t- <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space El Quantity [::]Type El Residue <br /> El Partial Rejection ❑Fuil Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number ~a <br /> i� <br /> J <br /> V <br /> tQ Faalit s Phone:. <br /> W 18c.Signature of Alternate Facility(or Generator) Month flay Year <br /> a <br /> Z <br /> N 19:Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatmen,disposal,and recycling systems) <br /> C 1. d 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 /> Printed/Typed Name- Signature rr� Day <br /> IfMonth Year <br /> EPA Form 13700-22(R�ev.3 05 Previous editions are obsolete. `` DESIGNATED FACILITY TO GENERATOR <br /> :�11x19 <br />