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SSL SK SHIP# 222068739 111111111111 111111111111111 OO 56953598 K8 Please print or type.(Form designed for use on elite(12-pitch)typewriter.) ]] e�epgy er�ge p Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number CAD050365188 2 Page 1 3 r tlig10-46r ne 4.Manliest Tradting Number WASTE MANIFEST 0 8 9 5359 SKS 5.Generators Name and Mafitig Address Generators She Address(S different than mailing address) Averon International 10100 W Linne Rd TRACY CA 95377-9128 Generators Phone: 421-000-300@ s.Tr,WsmderlLprnpApyElAcpq SYSTEMS INC U.S.EPA ID Number T�yXROOOS81205 , 7.Transporter I2 YCompany Name U.S.EPA ID Number _;/ 8.Designated Facility Name and Site Address THERMO FLUIDS INC U.S.EPA ID Number , 4301 W JEFFERSON ST PHOENIX , AZ 85043 800-350-7565 AZR000003681 Faciliys Phone: I . ga 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13Waste Codes HM and Pacidng Group(if any)) No. Type Quantity wtivol. 1. NON—RCRA HAZARDOUS WASTE SOLID DM P 223 o (DRAINED/UNDRAINED USED 5IL FILTERS) 5dv z z. W x7 3. 4. 14.Special Handling Instructions and Additional Informabon TSD:TPA 73357360 AM26175 201715 CSG:24 UA, 24 HR EMERGENCY # 800-468-1760(SAFETY—KLEEN) —1 b (lP Z AUTH AS "AGENT—FOR" BY GEN TO RETAIN LICENSED SUB CARRIERS AS NECES RY 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment am fully and accurately described above by the proper shipping new,and are classified,package , marked and labeled/placarded,and am in all respects in proper condition for transport according to applicable intemafianal and national governmental regulations.R export shipment and I am the Primary Fxpoder,I certify that the contents of this consignment cwdorm to the terms of the attached EPA Acknowledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a)it I am a large quantity generator)or(b)it am a small qua generator)is We. Gonerater M a P/'�feNfvr Name Signature Monts Day Year X Jnr c. Icy i7 .J 16.Intemational Shipments H ❑Import to U.S. Export from U.S. Pod of entry/exit a Transporter signature(for exports only): Date leaving U.S.: 17.Transporter Acknowledgment of Receipt of Viatedas Transporter 1 Printedrryped Name Signature Month Da Year I-) ( i1 a spod�er print yped Name Signature Month Day Year r ,CSU'✓�� M• �� } 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Pisru Rejection ❑Full Rejection Manifest Reference Number 18b.Alternate Facility(or Generator) U.S.EPA ID Number J U LL Facifity's Phone: w 1Sc.Signature of Alternate Facility(or Generator) Month Day Year z H19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treaMem,disposal,and recycling systems) 1. is 2. 3. 4. 20.Designated Facility Owner mrator..Certification of receipt of h ous materials covered by the manifest except as ncted in Item 18a PrmteNfyped Name Signature Month_ Da Year EPt5a%5 6l�/Ev1. 5y editionsareobsolete. DESIGNATED F ILITY O DESTINATION STATE(IF REQUIRED)