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SSL SK SHIP# 229105955 Iloilo <br /> 0 0 7 1 3 1 9 5 7 S K S <br /> Please print or type. Form Approved.OMS No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 rf 3. meq - spn�se PIS 4.Manifest Tracking Number <br /> WASTE MANIFEST TttR01�0081�05 1 � t�1�t0 �bt3—1 /E�sO �1�/S <br /> 5.Generators Name and Mailing Address Generator's Site Address(if different than mailing address) SKS <br /> SAFETY--KLEEN SYSTEMS, INC. SAFETY--KLEEN SYSTEMS, INC. <br /> PO BOX 555 5050 SALIDA BLVD <br /> SALIDA CA 95368 <br /> Generators Phone: 209-545--1011 SAI..I DA CA 95368 <br /> "Truer ft�l,C,o tl —V SYSTEMS INC U.S.EPA ID Number T X R00008 i 205 <br /> 7.Transporter[2 Company Name U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address SAFETY—KLEEN OF CALIFORNIA U.S.EPA ID Number <br /> 6880 SMITH AVE. <br /> NEWARK , CA 94560 <br /> CAD980887418 <br /> 510-795--4400 <br /> Facll" s Phone: <br /> ga, 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes <br /> HM and Packing Group('d any)) No. Type Quantity Wt.Nol, <br /> 1 NON—RCRA HAZARDOUS WASTE, LIQUID TT S 221 <br /> o (USED OIL) <br /> a� J iV <br /> W <br /> t� <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional information TSD:EVG SAL CSG <br /> 24H EMERSENCY#800-468-1750—CH/SK/TFI—Contract retained by generator confers agency authori ly <br /> initial trAn1porter to add or substitute , <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 labeledfplacarded,and are in all respects in proper condition for transport according to applicable intemationaland 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 EPAAcknowledgment of Consent. <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity genera"(b)(if I am a small qua 'ty generator}is true. <br /> Ms�Kw�eroes Printedff ame Si re Month Day Year <br /> 2 ?, -rzo <br /> 16.Intemationaf Shipments <br /> ❑Import to U.S. Export from Port of entrylexit: <br /> Transporter signature(for exports only): Dais leaving U.S.: <br /> W 17.TransporterAcknonledgment of Receipt of Materials <br /> T rtsporter 1 Printedffyped Na Sign Month Day Year <br /> sw Sl v a 2 20 <br /> Transporter 2 Printedfryped Name SigniGre Month Day Year <br /> 18.Discrepancy <br /> t8a.Discrepancy Indication Space ❑ quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number. <br /> 18b.Aitemate Facility(or Generator) U.S.EPA ID Number <br /> V <br /> tom+ Farility's Phone: <br /> a 18c.Signature of Altemate Facility(or Generator) Month Day Year <br /> X <br /> H19.Hazardous Waste Report Management Method Codes(i.e..codes for hazardous waste treatment,disposal,and recycling systems) <br /> A 1. 2. 3. 4. <br /> 20.Designated Facility Owner or Operator Certification of receipt of hazardous materials covered by the manifest except as notein Item 18a <br /> Nn yped Name ., Signature - Month Day Year <br /> pp�o.z�f� 61 a PIC) <br /> EPI Form <br /> Z49/�56�1�) Previous editions are obsolete. NATED FACILITY TO EPA's e-MANIFEST SYSTEM <br />