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LADING/MANIFEST 1.Shipper's US EPA ID No.(If Applicable) Document No. 2•Page 1 <br /> C 1-00-40:3468-75 AIA I Of <br /> ars Name and Mailing Address ADESA — Golden Gate <br /> 18501. West Stanford Rd <br /> Attn Samuel Mchenry <br /> TRACY CA 95377 <br /> ,.Shipper's Phone( P-057-..839-3888 <br /> 5.Transporter 1 Company NarrYg�,,' 6. US EPA ID Number A.Transporter's Phone <br /> SAFETY—KLEEN SYSTEMS INC972-295-2000 Transporter 2 Company Name 8. US EPA ID Number ;3.Transporters Phone <br /> . . . . . .• . <br /> 9.Designated Facility Name and Site Address EVG 10. US EPA ID Number C.Facility's Phone <br /> SAFETY-KL_EEN OF CALIFORNIA <br /> 6880 SMITH AVE. <br /> NEWARK CA 94560 CAD980887418 510-795-4400 <br /> i <br /> 11.Shipping Name and Description 12.Containers 13. 14. <br /> Total Unit <br /> HM No. Type Quantity Aft/vol <br /> a NON-REGULATED LIQUID (VAC-OIL WATER <br /> SLUDGE) (NOT USDOT/NOT USERA REGULATLD) TT G <br /> (NOT CA REGULATED) <br /> b. �QQ <br /> S' <br /> H <br /> I C. <br /> P <br /> P` <br /> E <br /> R d. <br /> c. <br /> i <br /> 15.Special Handling Instruction and Additional Information j <br /> SK SHIP# 230251129 AD20198 <br /> ADESA - Golden Gat-e .' <br /> 18501 Stanford Rd <br /> Attn Lester Sabo ! <br /> TRACY CA 95,.377-9708 <br /> 81801989 <br /> E4H EMERG# 800-468-1760(CH-SK-TFI)-TRANS RUTH TO RETAIN ADD' L CARRIERS <br /> DOT/ON1`"rEr097 B. C. D. <br /> A) NONE B))E_ C)C) D) <br /> 16a.US DOT HAZARDOUS MATERIALS SHIPPER'S CERTIFICATION' This Is to certify that the above-named materials are properly classified,described,packaged,ma ked end labeled and ere in proper <br /> condition for trans rtation according to thea applicable regulations of the De artment of Trans ortation. <br /> Printed/Typed Name Month Day Year <br /> 16b.NON-REGULATEDSHIPPER'S CERTIFICATION: I certify the materials described above on this form are not subject to federal regulations for Transportation or Disposal. <br /> Printed/Typed Name A Month Day Year <br /> T <br /> R" 17.Transporter 1 Acknowledgement of Receipt of Materials <br /> A nnted/Typed Name Si ature <br /> N s a, Month Day Year <br /> S <br /> P . lavlap- <br /> 0 18.Transp r 2 Acknowledgement of Receipt Materials <br /> R Printed/Typed ed Name <br /> T YP Signaturet f Month Day Year AN <br /> E <br /> R `• <br /> 19.Discrepancy Indication Space <br /> F <br /> A <br /> C <br /> L 20.Facility Owner or Operator:Certification of receipt of materials covered by this form except as noted in Item 19. <br /> T <br /> Y Printed /peedd,Name Signature onth Day Year <br /> f <br /> ORIGINAL-RETURN TO GENERATOR �� t _tFORM NO.01-90291(03/2015) <br />