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t SSL ' A. SK SHIP# 227955216 <br /> Please print or type. Form Approved.'OMB No.2050-0039 <br /> UNIF RM HAZARDO $ 1.GeoerMorID Number 2.Pe 1 of 3. m R99ssagqpse gg c 4.Manifest Tracking Number SKS <br /> STE MANIFEST <br /> . . .. <br /> 05.Ge erator's N,gme and Mailin Address Genera Ys Site Address(if different than mailin address), <br /> I DESA C,olden Sate DESA'= Solden ai e <br /> 18501 Most- Stanford Rd Attn Samuel Mchenry 18501 ,Stanford Rd <br /> TRACY 95377 Attn Lester Saba <br /> GeneratorsPhonCe: 20917� 4-5374 TRACY CA 95377-:-97(68 <br /> 6,T Ya SYSTEMSINC U.S.EPA ID Number <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address SAFETY-KLEEN OF CALIFORNIA U.S,EPA ID Nomber ff <br /> 6880 SMITH AVE. <br /> NEWARK , CA 94560 <br /> 510-795-4400 CAD980887418 <br /> Facility's Phone: <br /> ga 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste,Godes <br /> HM." .and Packing Group(if any)) No. Type Quantity,, Wt.NoI. <br /> 1 NO -°RCRA HAZARDOUS WASTE, LIQUI TT � � G 221 <br /> o (USED OIL) C>O I <br /> � z. <br /> w <br /> c� <br /> 3 <br /> 4., <br /> 14.Special Handling Instructions and Additional Information TSD s EV8 AD20198 CSG I <br /> 546 ' EMERGENCY 6 --468-17 �Ct�/514ITFX—Contract reined by generator confers aenvy authors <br /> on' idstial `transporter to add or substitute additional transporters on enera ors behalf. <br /> 15. GENERATORS/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 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 EPA Acknowledgment of Consent. <br /> I fy that he waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b if I it quantity generator)is true. <br /> Genet or's/Offe is Printedfryped ame .' natur Mon h Day, Year <br /> 16.InternatPnal Shipments <br /> F- ❑Import to U.S. ❑Exa6ftjem U.S. Port of entry/exit: <br /> 2 ,Transporter signature(for exports only): Date leaving U.S,: <br /> 17.TransporterkknowledgmentofReceipt ofMaterials <br /> _ <br /> Tran ort r 4 Printed(ry a Sig re Month Day Ye <br /> ' <br /> IL <br /> raospoder nnntedfrypedName a Month Day Year <br /> 18,Discrepancy <br /> 18a.Discrepancy Indication SpaceEl Y <br /> Quantity 1-1 Type El Residue ❑Parliai Rejection 1:1 Full Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number da <br /> ua. Facility's Phone: <br /> W 18c:Signature of Alternate Facility(or Generator) Month Day Year <br /> Q <br /> Z <br /> S 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 2' 3. 4' <br /> l <br /> 20.Designated Facility Owperof Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Printedfryped Name Signature Mont Da "Year <br /> " Cf� , <br /> EPA o ) Previous editions are obsolete. DESIGNATED FACILITY TO GENERATOR <br />