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SSL SK SHIP# 216895569 Jar VIII{I IIIIllll ulll1111111111111111 0 0 5 0 2 8 8 2 8 S K S Please print or type,(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMS No.2050-0039 UNIFORM HAZARDOUS I t-Generator ID Number , � 2.Paget of 3. meap�ft��yy Resmpop5ee P 4.(Nt�anitest Tra(c�kin NuQmW Q Rt lOI GQ13 1 tl KJ Fbd —�� V O 5 V 2 V V 2 8 SKS WASTE MANIFEST 5.GeneWors Name and Mailin Address Generatar s Site Address{if different than mailing address) SAFETY—KLEE14 SYSTEMS, INC. SAFETY--KLEEN SYSTEMS, INC. PO BOX 555 505 + SALIDA BLVD SRL I DA CA 95368 Generator's Phona: 209-545-1011 SAL.I DA C€# 95368 6.T'§WMf—Xt'N SYSTEMS, INC. U.S.EPA ID Number TX ROOOOB 1205 7.Transporter 2 YCo�mpany Name U.S.EPA iD Number 8.Designated Facility Name and Site Address SAFETY„„{LEEN OF CALIFORNIA, INC. U.S.EPA 10 Number 6880 SMITH AVE. NEWARK , CR 94560CAD980887418 510--795-4400 Facility's Phone' 9a 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10-Containers 11,Total 12.Unit HM and Packing Group(if ary)) No. Type Quantity Wt.lvol. 13.Waste Codes 1 1. NON—RCRA HAZARDOUS WASTE, LIQUID TT S 221 o (USED OIL) _— ©o Z 2. W 3. I i 4. i 14.Special Handling Instructions and Additional Information TSD'EVS SAL CSS: E 24 HR EMERGENCY #1-800-468-1760 (SK / TFI) AUTHORIZED AS "AGENT—FOR" BY GENERATOR TO RETAIN LICENSED SUBSEQUENT CARRIERS A5 NECESSARY 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, marked and€abeledlplacarded,and are in all respects in proper condition for transport according to applicable intemati 1 and national govemmentai reguiations.If export shipment and I art}the Primary Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgm tot sent. I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quanfity generato r(b I am a small quantity generator)is true. Generat s Offemns PrintedlType Vame &gnatu Mooth Day Year `a 16 lntemahonal Shipments ❑Import to U S. ❑Export from U.S. r Port of enlryJexiL _ -� Transporter signature(for exports only): gate I ving U,S.: 17.Transporter AcknowEedgment of Receipt of Materials Transporter Pnnted/Typed Name Signature Month Day Year � a l,r Z TransWer 2 PrilritedfTyped Name Signature Month Day Year 18,Discrepancy 18a.Discrepancy Indication Space Quantity ❑Type L1 Residue ❑Partial Rejection EJ Full Rejection Manifest Reference Number: 18b.Altemate Facility(or Generator) U.S.EPA tD Number J U Facility's Phone: LU 18c.Signature of Alternate Facility(or Generator) Month Day Year a Z cup 19.Hazardous Waste Report Management Method Codes(i.e..codes for hazardous waste treatment,disposal,and recycling systems) W 2, 3. 4. 0 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest excep oted in Item 18a Pn yped Name Signature Month Day Year EPA Form B7700-22 Rev.3-05) Previous editions are obsolete, DESIGNA FACILITYTQPEST TION STATE IF REQUIRED)