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SSL SK SHIP# 2.352.35105 II�I��II�II�IIII��II��III��I�IIIIIII <br /> 008143443SKS <br /> Please print or type. Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 3 2 Peg 1 of 3 E y e se 4.Manifest Tracking Number <br /> cAR0000�9�70 g 1 � � �' 1008143443 SKS <br /> WASTE MANIFEST <br /> 5.Generator's Name and Mailing Address GeneTat9fs Site Address(If different than mailing address) <br /> Escalon Premier Brands Inc. <br /> 1505 Mchenry Ave <br /> E:SCALON CA 95;32.0-0000 <br /> Generator's Phone: 09-552.-6051 <br /> s.TSNEI wr V—MkNe SYSTEMS INC U.s.EPA 1p Number TX R000081205 <br /> 7.Trannsspporrtter�2 Company Name U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address THERM© FLUIDS 1 NC U-S.EPA 10 Number <br /> 12.533 SE CARPENTER DR <br /> CLACKAMAS , OR 97015-8988 <br /> 503-796-4616 0139000025197Fadi@y's Phone: <br /> 9a 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit <br /> 13.Waste Codes <br /> HM and Packing Group(if any)) No. Type Quantity Wt.Nol. <br /> 1. NON-RCRA HAZARDOUS WASTE SOLID DM P 223 <br /> o (DRAINED/UNDRAINED USED bIL FILTERS; ` 2� <br /> � 1 I <br /> w <br /> z 2. <br /> LU <br /> 3. <br /> 4. <br /> El <br /> 14.Special Handling Instructions and Additional Information TSD 9 TPtO 8722 5,346 ES 12.014 2.02.136 CSG•21 <br /> 24H EMERGENCY#800-468-1760-CH/S-,,"Fi-Contract reiained by generator- confers aggency artthorit% <br /> on initial transporter to add or substitmte additional transporters on enerator' s behalf. <br /> 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, <br /> 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 <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 a small quantity generator)is true. <br /> oxatar's,+Offerpr`s PrintedfTyped Name _ I at Month Day Year <br /> ox <br /> V--A,0 a E Yr� <br /> J 16.International Shipments <br /> H ❑Import to U.S. ❑Export from U.S. Port of entry/exit: <br /> ? Transporter signature(for exports only): Date leaving U.S.: <br /> W 17.Transporter Acknowledgment of Receipt of Materials <br /> I.– T sportar t PrintedlCyped Name Sign Month Dayp Year <br /> O L �f <br /> a <br /> U) Transporter 211 rintedrFyped Name Si ature Month Day Year <br /> ksIM I 0T I <br /> 18.Discrepancy <br /> 18a,Discrepancy Indication Space El Quantity El Type ❑Residue Partial Rejection F-1 Full Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S,EPA ID Number <br /> J <br /> U <br /> Facility's Phone: <br /> w 18c.Signature of Atlernate Facilly(or Generator) Month Day Year <br /> Q <br /> z <br /> y19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> LU 1' H141 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 1 Be <br /> Printed., yped Namef 5 gntrni Ih Day Year <br /> VA 4 4 I� <br /> EP(fiy r g -20y�ffiRrevious editions are obsolete. DESIGNATED FACILITY TO EPA's a-MA (FEST SYSTEM <br />