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SSL SK SHIP# 232805353 U�NI�N{IIIj11f � � <br /> Please print or type. <br /> 0071770414SKS <br /> Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1-Generator 10 Number TXROOOO81205 2'Pisgah d 3. ''R W&F-T'9 @ 4.Nanlfa I TackiNamber <br /> WASTE MANIFEST 007710414 SKS <br /> 5."0gA _At99 TEMS, INC. GemPle? ;)INC. <br /> PO BOX 555 5050 SALIDA BLVD <br /> SALIDA CA 95368 <br /> Generators Phone: 209--545-1011 SALIDA CA 95368 <br /> 6.TgffPVSYSTEMS INC U.S.EPA ID Number TXROOOO81205 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> S.Designated Facility Name and Site Address SAFETY—KLEEN OF CALIFILINNIR U.S.EPA ID Number <br /> 6880 SMITH AVE. <br /> NEWARK , CA 94550 <br /> 510-795-4400 CAD980887418 <br /> Fadti sPhone: <br /> ge, 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Gass,ID Number, 10.Containers 11.Total 12.Una 13.Waste Codes <br /> HM and Pecking Group it any)) No. Type Quantity Wtivol. <br /> 1. NON—RCR HAZARDOUSWASTE, LIQUID TT 6 221 <br /> (USED OIL) <br /> joyin <br /> �a <br /> W <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Add tOp l Infamabm C <br /> 24H EMERGENCY#800-468-1750—CH/SK/TFI—Contract retained by generator confers agency authori y <br /> an initial transporter to add or substitute additional transporters on generatar'rs behalf. <br /> 15. GENERATOR'S10FFERDR'S CERTIFICATION:1 hereby declare that the contents ofthis consignment are fully and accurately described above by the propershipping name,and are classified,packaged, <br /> marked and labeleNplacarded,and are in all respells in proper condition for t nnsport according to applicable international and national governmental regulations.It export shipment and I ant the Primary <br /> Exporter,I cefiy,that the contents of this consignment conform to the terms of the Attached EPA Acknowledgment of Consent <br /> I ceNfy Ill the waste minrmizebon stabomem ider00 in 40 CFR 262.27(a)('d I am a large quanty or(b)(a I aml small quantity gmembor)is hue. - <br /> s+Oterors Name <br /> C7-A <br /> Month Dey veer <br /> 16.Intematianal Shipments <br /> p ❑Import to U.S. ❑E Wy U.S. Pal of enbylok <br /> ? Transporter signature(for expots only): Date leaving U.S.: <br /> W 17.Transporter Admovdedgmert of Receipt d Materials <br /> r i Printedrfyped N Mash Day Year <br /> O <br /> a <br /> Transposer 2 PnntWTyWNarria Moth Day Year <br /> 18.icy <br /> 18s,Discrepancy Indication Space ❑Ouarday ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manikst Reference Number: <br /> 18b.Alternate Facility(a Generator) U.S.EPA ID Number <br /> J <br /> U <br /> Factitys Phone: <br /> W 18c.Signature dAaemate Facility(orGenerator) Month Day Year <br /> Q <br /> 2 <br /> y19.Hazardous Waste Report Management Metal Codes(i.e..codes for hazardous waste Irealment,disposal,and recycling systems) <br /> 01. AID <br /> 20.Designated Facility Owner or Operator.Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> PrintedRyped Name Signature Month y Year <br /> !/ ' <br /> EPl�ilg$�& g& ) Previous aditorls are obsolete. SIESPNATED FACILITY TO EPA's 9-MANIFEST SYSTEM <br /> OR14472_WT_007770414SKS 16 <br />