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SSL SK SHIP# 232164047 Boa loll Please print or type. 0 0 7 7 7 1 1 4 7 5 K i Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number Q.Y.80000$j EE05 2.Nagai of 3. rn�Raspogse thane 0 4.Manifest Tracking Num WASTE MANIFEST �i 7 t 5 1007771blerO7 SKS5.Generator's Name and Mailin Address Generatoes Sitee Address('d differerd than maifin address) y� SAFETY—KLEEq SYSTEMS, INC. SAFETY--KLEEN SYSTEMS, INC. PO BOX 555 5050 SALIDA BLVD SALIDA CA 95368 Generator's Phone: 0' —'545-1+ 11 SALIDA CA 95368 SYSTEMS INC U.S.EPA ID Number TXR@00081205 7.Transporter(2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site AddressSAFI=TY—t;LEEN OF CALIFORNIA U.S.EPA ID Number 6880 SMITH AVE. NEWARK , CA 9�560 �+/'�y��y�7 {y p� )� n 510-795-4400 Srt1L 7Q��7Q�Y�0 Facililys Phone: `.i 9e. 9b.U.S.DOT Description(including Proper Shyhping Name,Hazard Class,ID Number, 14.Containers 11.Total 12.Unit HM and Packing Group(if any)) No. Type Quantity MAV. 13.Waste Codes 1' NON—RCRA HAZARDOUS WASTE, LIQUID TT 6 22�1 aO (USED AIL) Z2 C5 3, 4. 14.Special Handling Instructions and Additional Informetion TSD C EVG SAL \ CSG: i 24H EMERGENCY#800-458--1760—GH/SK/TEI—Contract retained by generator confers agenvy authori y- on initial transporter to add or substitute additional trans orters on genera behalf. 15. GENERATOR'SIOFfEROR'S CERTIFICATION: 1 hereby declare that the contents of this consignment are fuly and accurately described above by the proper shipping name,and are classified,packaged, marked and labeledlplaearded,and are in all respects in proper condition for transport according to applicable international and national govern I regulations.t export shipment and I am the Primary Exporter,I ce*that the contents of this consignment==form to the terms of the atached EPAAcknowh*ment of Consent I certify that the waste minimization statement identified in 40 CFR 26227(s)(if I am a large quantity generator)or(b)(if l am a qua ' gewwtA"or)is true. Ge»eratorslOft Prtn*nypedN Signature Month Day Year � 16.Inlemational Shipments ❑Impart to U.S. ❑Export from U.S. Er /exit Transporter signature(for exports only): lir 17.Transporter Acknowledgment of Receipt of Mal srials WTransporter 1 Pri Name - Signature Month Day Year W � t � I W Tra 2 Printed/Typed Name Signature Month Day Year F 18.Discrepancy 18a.Discrepancy Indica5on Space ❑ Quardity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number. 18b.ANemate Facrlity(or Generate) U.S.EPA ID Number C.1 ac tit's Phone: Q18c.Signature of Alternate facility(or Generator) Month Day Year z 19.Hazardous Waste Report Management Method Codes(Le.,codes for hazardous waste Ineahnent,disposal,and recycling systems) W 1. //V 3 2. 3. T "Ph y Owner or Operator.Codification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Signature Month Day Year lie EPJ�fjg4q!R�ji�) Previous editions are obsolete. IMPSIGNATED FACILITY TO EPA'S e-mANIFESt SYSTEM