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SSL SK SHIP# 227956215 ') <br /> lease,print or type. 4 r. y Form Approved.OMB No.2050-0039 <br /> i NIFORM H9' RDOUS TtOeneralor ID Number 2.Pad 1 of 3. m R e 4,Mani est Tracki Number <br /> ' CAL000346875 t�1 fm # :MIS SKS <br /> WAST 'ANIFEST•' <br /> 5.Ge era o sName and Mailin Address Generator's Si ddress if diff re t than ailjn address <br /> t DE A — Solailen Gate ADAA -- (So�l�en `'Gave ) <br /> 18501 West Stanford Rd Attn. Saeuel" Mchenry 18$01 Stanford Rd <br /> TRACY CA 95377 Attn Lester 'Sabo <br /> generator's Phone: 20• #14"5374., TRACY CA 95377-9708 <br /> 6 <br /> Twevwft SYSTEMS INC U:S.EPA ID Number TXR006081205 <br /> 7.Tr psporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address SAFETY—KLEEN OF CAL.IFORMIA U.S.EPA ID Number <br /> 5880 SMITH AVE® <br /> NEWARK s CA 94560 <br /> 510-795-44M CAD989887418 <br /> F.dlitys Phone: <br /> 9a• 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers11.Total 12.Unit 13.VPaste Codes <br /> HM and Packing Group(if any)) <br /> No. Type Quantity Wt.NoI. <br /> 1. X14 —RCRA HAZARDOUS o WASTE LIQUID TT � G 221(USED OIL) � <br /> z-. 2 <br /> UJ <br /> .,4 <br /> 3. <br /> 4 <br /> •r <br /> FI <br /> a�r <br /> s. 14.Special HandlingInstructions and dditional Information <br /> TSDsEVG AD20198 CSG: <br /> 2�+H 9MERSENCY#800-468-1760—CH/SK/TFT—Contract retained by generator confers a endy authori y <br /> on initial trains orter to add or substitute additional trans orters on enera or' 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 andJabeled/plac2rded,and are in all respects in proper condition for transport according to applicable international nd national governmental regulations.If export shipment and 1 am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Co ant. <br /> I certify that the waste minimization gtatement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or am a sinal(quantity generator)is true. <br /> Genera tor'slOfferorsPrintedfTyped Name Signature: Month Day Year <br /> 16.International Shipments <br /> Import to U.S. ❑Export from U.S. Port of entry/exit: <br /> Transporter signature(for exports only):' Date leaving U.S.: <br /> W 17.TransporterAcknowledgment of Receipt of Materials <br /> Trans `ter 1 Printetl/Typed N e Sig u Month Day Year <br /> IL <br /> ansporter inted/Typed Name Signature Month Day Year <br /> H F <br /> 18:Discrepancy <br /> 18a.Discrepancy Indication Space QuantityType� yp ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> 18b:Alternate Facility(or'Generator) U.S.EPA ID Number 3 <br /> W Facility's Phone: <br /> F18a Signature of Alternate Facility(or Generator) Month Day Year <br /> Z <br /> 19.Ha ardous Waste Report Management Method Codes(i,e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> co <br /> III <br /> 1. 2. 3; 4. <br /> 20;Designated Facility Owner or Operator:Certification of res of hazardous materials covered by the manifest except as noted in Item 18a <br /> PrintedfTyped Name Sig Month Day Year <br /> 4 i 0 �� l <br /> EPi)o11ZV!ft1 ) Prewous ditions are obsolete: DESIGNATED FACILITY TO GENERATOR <br /> t <br />