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SSLSHI> 57956E4 y , <br /> Please nt type,.,;, Form Approved:OMB No.2050-003 <br /> UNIFORM HAZARDOUS 1.Generator ID Number CFiL0f �3 2.lag 1 of 3. m R e 4,Manifest Tracking Number <br /> 46875 � - I SKS <br /> _ WASTE MANIFEST0,06953.44-9. <br /> 6> a erator'sName and Mailin Address Generator's Site Address(if different than marlin address) <br /> ADESA w Gol9'en rate ADESA Golden Gere <br /> 18501 West Stanford Rd Attn SaM001 Echpnry 18501 Stanford Rd <br /> mh"1RACY CA 95377 Attn Lester Sabo <br /> Generators Phone: 2 814-5374 TRACY r CA. 9537'7-5708' <br /> -8:T o n �" U.S. Number V , SYSTEMS INC EPA ID NuTX0@00818105 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> S.Designated Facility Name and Site Address °ETY-+LEEN a CAL T FORNI€� U.S.EPA ID Number <br /> SBSG S141TH AVE. <br /> NEWARK 9 CA 9456 , <br /> 510-795-•44 ,� � CAD980887418 <br /> Facility's Phone: <br /> 9a. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit j3.Waste Codes <br /> HM and Packing Group(if any)) No. T quantity Wt.NOI. <br /> 1. NON-RGRA HAZARDOUS WASTE, LIQUID TT G 221 <br /> o. (USED OIL.) 2� <br /> z 2: <br /> LU <br /> 0 Y <br /> $ g. <br /> 4. <br /> 3.' <br /> 14•Special HandlInstructions <br /> Handling and Additional Information m <br /> .._. . TSD�EVG __A11E�1�8.. :,0130 <br /> 24H EMRG�NCY B -488-1760-CH/SK/TFI--Contract ,retained by generatoru• 'gn er- a envy authori y <br /> on initial. trait drtor to add or substitute. additional transporter nera or's behalf.. <br /> 15. GENERATOR'S/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 EPAAcknowledgment of Consent. <br /> I cedifythat the waste minimization statement identified in 40 CFR 262.27(a)(if I am alarge quantity generator)or(b)(if i am a small quantitygenerator),is true. <br /> Generator's/Offeror's Printed7Typed Name Signature Month Day Year <br /> 16,International Shipments. El' <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 /> UJ <br /> 77/ <br /> 1 P' ledffyp awe Signa a Month Day Year.. <br /> C / log C <br /> Transporter rintedfTyped Name Signature Month Day Year. <br /> t— <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space <br /> Quantity ❑Type- ❑Residue ❑Partial Rejection ❑Full Rejection <br /> 1 <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) _ U.S.EPA ID Number <br /> L;- Facility's Phone: ` f•.: <br /> LO 18c.Signature of Alternate Facility(or Generator) , Month Day Year <br /> z <br /> 19.Hazardous Waste Report:Management Method Codes(i.e.,codes for hazardous waste treatment,disposal;and recycling systems) <br /> 1. 2. 3. 4. <br /> 20.Designated Facility Owner.or Operator:Certification of receipt of hazardous materials;covered by the manifest except as noted in Item 18a <br /> PrintedlTyped Name SignatureMo Day Year <br /> EPA o 2- ) Previous editions are obsolete. DESIGNATED FACILITY 0 G NERATOR <br />