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eat.., on on i els CCppG.7C7,7 U ,`[ ` 1111111110 11111 Il l/llilll!li 11111111 IN <br /> 00666 ? 407SK6 <br /> Please print or type. Form Approved,OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1 Generator ID Number <br /> CAL000346875 1 tsi01D --2.Page 1 of 3. my_R se 4.Manifest Tracking Num r <br /> WASTE MANIFEST 1(6Q1 1006687407 <br /> �SKS5.Generator's Name and Mailing Address Generators Site Address(if different than mailing address) u n{� <br /> ADESA – Golden Sate ADESA Golden Sate <br /> 18581 West Stanford Rd Attn Samuel Mchenry 18501 Stanford Rd <br /> TRACY CA 95377 Attn Lester Sabo <br /> Generators Phone: 209-814-5374 TRACY CA 95377--9708 <br /> s.Trg&QVVXi SYSTEMS INC U.S.EPA ID Number T X R0000812'05 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 6.Designated Facility Name and Site Address SAF ETY--KLEEN OF CALIFORNIA U.S.EPA ID Number <br /> 9 SMITH AVE. <br /> 510-795-4408 NEWARK , CA 94560 CAD98ON7418 <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 Codes <br /> HM and Packing Group(Wany)) No. Type Quantity WtNd. <br /> 1' NON RCRA HAZARDOUS WASTEjLI(I1JID TT G 133 <br /> o ETHYLENE GLYCOL SOLUTION (LESS THAN 50 s S%) (DC7 C <br /> Z 2. <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional Information TSD:EVG AD20198 CSG: <br /> 24H EMERSENCY8800-468-1760-CH/SK/TFI-Contract retained by generator confers agency authori y <br /> n initial <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 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 certify that the waste minimization statement identified in 40 CFR 262.27(x)(if I am a large quantity )or(b)(tt m a small quantity natrue. <br /> Gene torsfOtfes Printed/T Sig Month Day Year <br /> Q � % L-1/ ZA--- 102 10Z, 2b <br /> 16.International Shipments <br /> ❑Import to U.S. ❑fxport . . Port oientry/axil: <br /> Transporter signature(for exports only): Date leaving U.S.: <br /> DC 17.Transporter Acknowledgment of Receipt of Materials <br /> Tran�1 PFnteYrlure Month Day Year <br /> I r — -- 10 ly� <br /> TransporteotPrintedtTyped Name Signature Month Day Year <br /> 18.Discrepancy <br /> 18a.Discrepancy indication Space R Quantity, ❑Type ❑Residuea) election <br /> ❑Partial Rejection ❑Full R' <br /> Manifest Reference Number. <br /> 18b.Altemate Facility(or Generator) U.S.EPA ID Number <br /> U <br /> uQ. Facility's Phone: <br /> 18c.Signature of Altemate Facility(or Generator) Month Day Year <br /> 19.Hazardous Waste Report Management Method Codes(i.e..codes for hazardous waste treatment,disposal,and recycling systems) <br /> o i � 4. <br /> ILtF77 <br /> 3. <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 yped Name Signature Month Day Year <br /> !��nl CA�V—,C-L, I A- 1 3 1 -2- Tx� <br /> EPA F%%8 0 ig LPe 12-17) Previous editions are obsolete. DESIGNATED FACILITY TO EPA's e•MANIFEST SYSTEM <br />