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SSL SK SPMA 22795€ 3 <br /> Meng/or type. Form Approved.OMB No.2050-0039 <br /> IfJNIFORM 1•Generator ID Number 2.Pae 1 of 3. m R e P 4.Manifest Tracking Number <br /> ��L�1���4 �5 9 � �� p �-�� <br /> 006953448 WASTE MANIFEST SKS <br /> 5.Generator's Name and Mailin Address Generator's Site Address(if different than mailingaddress) <br /> ADE - Golaen Gate ADESA �- Gulden Gae <br /> 18501 lest Stanford Rd Attn Saiguul Mchlenry 18501 Stanford <br /> TRACY I tf CA 95377 Yttn Lester Sabo <br /> Generator's Phone: ,r, <br /> 2 '�4-� 374 TTRACY CA 95377-9708 <br /> "MMq ` Y SYSTEMS INC U.S.EPA ID Number TX R 0001205 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address SAFETY-KLCEN OF CALIFORNIA U.S.EPA ID Number <br /> 6880 SMITH AVE. <br /> NEWARK � CA '��45�x <br /> 51'79 "144 CAD9 98741 D <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 13.Waste Codes <br /> HM and Packing Group(if any)) No. Type Quantity Wt.Nol. <br /> 1. NON-RCRA HAZARDOUS WASTE, LIQUID TT 6 1 <br /> o (USED OIL,) <br /> z 2. <br /> W <br /> 0 <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional Information TSDgEVG AD20198 OSS2 <br /> 24H t RGENCY m4 5-176 -CH/SK/TF'I-Crantract retained by generator confers ency;auth ori y <br /> on initial transporter to add or substitute additional transporters an enora orls' bebal-f, <br /> 15. GENERATOR'S10FFEROR'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 net' tal 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(a)(if I am a large quantity generator)or(b)(if I am'e s all quantity generator)is true. <br /> Generatoes/Off eor's Printed/TypedrName Signature r Month Day Year <br /> V, Z ,7( <br /> 16.International Shipments ^ <br /> I- ❑Import to U.S. ❑Export from U.S. Port of entrylexit: <br /> M Transporter signature(for exports only): Date leaving U.S.: <br /> W 17.Transporter Acknowledgment of Receipt of Materials <br /> Tran porter 1 Prinled/Typ d�l6 a Signat Month Day Year <br /> ee � Jot <br /> CL <br /> Z Transporte rintedrryped Name Signature Month Day Year <br /> F <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ i <br /> Quantity ❑ ❑ <br /> Type Residue El Partial Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number ` <br /> J is <br /> I <br /> LL Facility's Phone: <br /> W 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> a <br /> z <br /> 55 19.Hazardous Waste Report Management Method Codes(Le.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> G 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 /> Printed/Typed Name Signature Month Day Year <br /> EP Fo 87f02( v1Z.1 Previous editions are obsolete. GENERATOR'S INITIAL COPY <br />