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SSL SK SHIP# 2333152@1 1111111111111 oil I III III <br /> Please print or type. 0 0 7 5 r 4 5 8 8 S K.S{ <br /> Form Approved.OMB No,2050.0038 <br /> UNIFORM K62ARDOUS I 1.Generator ID Number � �1 � 2.Page11 of 3 mE Rasnoose h � 4.Manifest Tracking Number <br /> 1NA57E MANIFEST 0 0 7 5 7 4 588 SKS <br /> 5.G9WM- d NEMS, INC. %WVgyEW'INC. <br /> HIDA 555 CR 95368 5050 SALIDA BLVD <br /> Generators Phone: 209-545-1011 SAAL I DA CA 95368 <br /> `TVV&V0kn 9W— SYSTM INC U.S.EPA ID Number TX ROON81805 <br /> 7.Transporter 2 Company Name U.S-EPA ID Numb <br /> 8,Designated Facrltly Name and Site Address SAFETY—KLEEN OF CALIFORNIA U.S.EPA lD Number <br /> SSW SMITH AVE. <br /> 510-795— NEWARK CA 94r'568 <br /> Farslit>rs Pitons: 510-795-44M <br /> ga. gb.U-S.DOT Description{rxJuding Proper shipping Name,turd Class,ID Number, 1 10.Containers 11.Tota! T2- <br /> HM and Packing Getup(If any)) UnirNo. Type Quantity wuvd, 1a.Waste Codes <br /> 1 NON— RA HAIR WASTE, LICJID TT 221 <br /> r— <br /> (!USED OIL) <br /> Larp <br /> LU <br /> c� <br /> 3. <br /> 4, <br /> 14,Special Handling Instructions and Addhomal information 79MEM SAL 2 <br /> ?-4H EMER6ENCY#M-468-1760—CH/Sit/TFI—Contract retained by generator confers agency atuthori y <br /> on initial transporter to add or substitute additional trans orters on eneraor�s behalf. <br /> 15. GEltERATOR SfpFFERDR S CERTtF1t,ATION: i hereby declare that the oontants of this consignment are fully and accurately described above by the proper slipping name,and are classified,packaged. <br /> marked and labele Retarded,and are in all respects in proper oandition for transport a=rching to applicable international and national governmental regulations-If <br /> Exporter,I ca*that the contents of this corns) m*M conform to the terms of the attached EPAAcknowl export shipment and I am the Primary <br /> I certify that the waste minimization statement identified in 40 CFR 2$2.27(a){'d I am a la edgment Consent <br /> large quantity gerrera�r]or(b)(if I V a snalkyjanbty generator)is hue. <br /> Genera PdntadlTyped Name Signature Month Day Year <br /> J 16.International S#ripmetris <br /> Es3 1091 Z4 <br /> ❑Import to U.S. ❑Export from U.S. rt of wiry xat: <br /> Tmnsportarsignature(for exports only): Date issuing U.S.: <br /> W 17.TranspoderAdm!6dedgmerd of Receipt of Matariafs <br /> Transporter 1 P' yped Name5ignahrre <br /> f Month Day Years <br /> Transporter. Print cVTypedName Sign >re �� �L <br /> Month Day Year <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Q.tity ❑Tye ❑Residue <br /> ❑Partial Rejection El Full Rejection <br /> 18b,Aftemate Facility[or Generator] Manifest Reference Number- <br /> U.S-EPA ID Number <br /> U <br /> LL FactiiVs Phone: <br /> M18c-Signature of Altemate Facility[or Generator] <br /> Month Day Year <br /> Y <br /> 19,Hazardous Waste Report Management Method Codes[i.a.,codes far hazardous waste treabnenl,disposal,and recycling systems} <br /> O 1.LU -l i 03 I 2. 4. <br /> V 3. <br /> 20.Designated Fatality Owrser or Operator.Cerfification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Prin Name �� ��� Signal Cl:fC��D <br /> Month Day Year <br /> EPti jj F4t� il.l) Previous editionsare obsolete. ACILITY�rl �.. <br /> AN1FE5T SYSTEM <br />