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SSL K SHIP# 227956214 � ' <br /> Please pri(t r type. Form Approved,OMB No:2050-0039 <br /> IY FORM HAZARDOUS 1. ener fgr ID Number CAL@00346675 <br /> 12.Page11 of 3. m �Ra a Bharte 4,Mali st Tracking Number KS <br /> WASTE MANIFEST, J 1006953439 <br /> 5.Generator's Name and Mallin Address Generators Site Address(if different than mailin address) <br /> ADESA Goldfen Gate ADESA - Golden Gate <br /> 15501 West`Stanford Rd Attn Samuel Mchenry 16501 Stanford Rd <br /> TRACYCA 95377 Attn Lester Sabo <br /> Generators.hone: i09*4-5374 TRACY CA 95377-a'9708 <br /> 6.T " `�fo°V SYSTEMS INC; U.S.EPAIDNumber TXR000081205 <br /> 7.Transporter 2 Company Name U.S.EP� Number <br /> 8.Designated Facility Name and Site AddressSAFETY^`KI.EEN OF `C .LFRNt — U.S:EPA-ID Number- <br /> 6590 SMITH AVE <br /> NEWARK , CA 94560 <br /> 510-795x-4400 t` CAD98086 741 8 <br /> Facility's Phone: I <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 NON-RCRA HAZARDOUS WASTE, LIQUID TT G 221 <br /> o (USED OIL) 0© <br /> z 2. <br /> UJ <br /> C9 <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional Information TSD 9 EVG AD20198 CSG <br /> 24H EMERSENCY 800°-466-1760—CH/Sk/TFI—Contract retained by generator confers atganby authori 'y <br /> an initial transporter to add or substitute additional .trans orters on generator' s behalf.. <br /> 15. GENERATOR'SIOFFEROR'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 international and national governmental regulations.If export shipment and f am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. <br /> I certify that the waste minimization statement identified in 40 CFR 262,27(a)(if I am a large quantity generator)or(b)(if I am a small quantity generator)is true. <br /> Generators/Offeror Printed/Typed Name SignatureMo th Day Y <br /> ,ffy <br /> 16.IntAmahonal Shipments <br /> ❑Import to U.S. El Export from U.S. Port of entrylexit: <br /> Transporter signature(for-exports only): Date leaving U.S.: <br /> ' W 17.Transporter Acknowledgment of Receipt of Materials <br /> Tr spgrter-1 PrirttedANem nature Mont Da Year <br /> CL <br /> o !/(/ <br /> Z 'Transpo 2 PrintedlTyped Name Signature Month Day Year. <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity El Type 0 Residue ❑Partial Rejection El Full Rejection <br /> - Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) aH 7 U.S.EPA ID Number <br /> V <br /> u Facility's Phone: <br /> W <br /> 18c.Signature of Alternates Facility(or Generator) Month Day Year <br /> a <br /> z <br /> 19.Haz rdous Waste Repo Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> D 1. 4. <br /> 20.Designated Facility Owner or Operator:Certification of receipt of>w"materials coveLed,by the manifest except as noted in Item 18a <br /> Printed/Typed Name Signature Mo h Day Yegr <br /> EP oVg%?)ft& ) Previous editions are obsolete. DESIGNATED FACILITY TO GENERATOR <br />