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SK SHIP# 231942129 10 Please print or type. 007313659SKSForm Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1 1.Generator ID Number CAL00I0147E3 of 3G — to 4.Manifest Tracking Number WASTE MANIFEST 0 0 7 313 6 5 9 SKS 5.Generator's Name andMailing Address Generator's Site Address(if different than mailing address) Calaveras Materials Inc. 1945 Lathrop Rd LATHROP CA 95330-0000 Generators Phone: 559-469-3838 s.Tr r ].Corgpan f SYSTEMS INC U.S.EPA ID Number T X PO@0061205 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address SAFETY—KLEEN OF CALIFORNIA U.S.EPA ID Number 6880 SMITH AVE. NEWARK , CA 94560 CAD980887418 510-795-4400 Facility's Phone: ga. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit HM and Packing Group(if any)) 13.Waste Codes No. Type Quantity Wt.Nol. 1. NON-RCRA HAZARDOUS TASTE, T' G 221 o LIQUIDS, (WASTE OIL), r 7- 15/ Z Z. LU C9 3. 4. 14.Special Handling Instructions and Additional Information TSD:EVG 83776381 CA67265 CSG: 24H EMERGENCY#800-468-1760—CH/SK/TFI—Contract retained by generator confers a ency authori v on initial transporter to ad or substitute additional transporters n en or' s behalf. 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, 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 Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. 1 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 a small quantity generator)is true. General IOfferor's Printed/Typed ame SignatureMonth Day Year !3 IZO J 16.Intemational Shipments ❑Import to U.S. ❑Export from U.S. Port of entry/exit: ? Transporter signature(for exports only): Date leaving U.S.: W 17.Transporter Acknowledgment of Receipt of Materials Transporter 1 Printe/Typed Name �_ Signature MonthDay Year a 7 i3 26 QTransporte Printedrryped Name Signature Month Day Year H 18.Discrepancy 18a.Discrepancy Indication Space Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number J U U Facility's Phone: LO 18c.Signature of Alternate Facility(or Generator) Month Day Year Q Z N19.Hazardous Waste Report/Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) LLJ p 1 V n n 2. 3. 4. 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Pdnted/Typed Name �r Signature Month Day Year G 2a EPA Form 8700-22Rev.12-1�7L Previous editions are obsolete. D ATED FACILITY TO EPA's a-M IF ST SYSTEM 1)8888359/204A66 Page 23