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Please prnl of type. (Ferns designed for use an elle 02-orch) hnicWter.l <br />9—e„mm,an ns,a er., anc.meae <br />_.., _.__ _- , . ....,,,, DESIGNATED FACILITYI"ENERATOR STATE (IF REQUIRED) <br />1)0014311 2) 0014941 3> 4) <br />UNIFORM HAZARDOUS 1. Generale, lO Numew 2. Page lel 3. Emergency Response Phone 4. Hangout Tracking Number .- <br />WASTE MANIFEST CAD982515900 _ SKS V(+ <br />a71�a7 <br />$. Genpmnrs Name eno M7iing Address Generale c ile AUdress(a dil tant man mulling address) <br />WINE GROUP INC <br />17000 E HWY 120 <br />RIPON CA 95366 <br />Generators Phone: -399-4111 <br />G.Trenspor lCompany Nema U.S,EPAIDNumber <br />SAFET'f-KLEEH SYSTEMS, IMC, I'XR0000309air <br />7.7 .. sponsor 2 Company Nam. U.S. FPA ID Nunmrm <br />B. Dmgnoled Fochl"a o and Silo Address SAFETY-KLEEht SYSTEMS, INC. 000760 U.S. EPAID Number <br />6000 88TH STREET <br />. SACRAMENTO CA 93828 <br />Fatlll Phone: 916-386-4913 CAOCOU084517 <br />gar <br />9b. US. DOT Descnptisn(ndudng PmperSNppbg Name, Hoard Crass, ID Number, <br />ID. Centel <br />in <br />It. Total <br />12. Unt <br />HM <br />and Packing OW(ifrnt)) <br />Quanlgy <br />WtNol. <br />Q. Waste CovinaNo. <br />Typo <br />NON-RCRA HAZARDOUS WASTE, LIQUID <br />) <br />OM <br />n <br />G <br />134 <br />(AOUEOUS IMMERSION CLEANER) <br />11 <br />1 <br />2NON-RCRA HAZARDOUS WASTE, LIQUID <br />DM <br />/ <br />G <br />134 <br />(AQUEOUS PARTS WASHER SOLUTION) <br />(\ <br />(� J <br />3. <br />4. <br />1/. Spacial Handilnp wwdbnsand AddiPorelnnmminn <br />SK TRCKNII0451307 0038769724 0000371458 0916 22 <br />GT <br />y-aoby the proper shipping now, erdoe clanged, packaged,1G. GENE AR'C <br />mamotl and lebalodlpramrdod, and are In all,aspecn In proprecand0bn for transport exon➢ng to streamlines Ntem homeland national governments] regulations. 11 export shymeMend I am the Primary <br />Exporter. I m-tly goal the comonla Cribb WnnilYanonlponlorm to UID tonns of the alllchad EPAAWowNpantol Consent. <br />Iaerer thelthBwaMerdnlnnetion slalomentldanUlkdn4DCFR29227(a)fln emelarge qumrtlrygenartlm)«ry)(Yl oma ganerelorikwe. <br />Ge OB refs Pnnle-rtypod Nnma a < Monty --9'V—yew <br />Q <br />—r <br />10, Interrog1511'0 nu <br />' MPo-IO U.S. Export (,a. U.S, Rod olanby/ozl: <br />Trens7,oder dgreNre(foraxpolk oNY) Dale leaving U.S.: <br />K <br />17. TmrepoderAcMnonledgmenldRecelptofMaterials <br />Thereto Pdniedriyped NB Sgnalure Monm Day Year <br />a <br />N <br />/ <br />V j'1 <br />Trans r2 Pdn ed RdIM a MA D <br />e r <br />1 <br />10. Discrepancy <br />f <br />16a. Discrepancy lndiwUon Spero ❑Ouertlir ❑Typo ❑RAsyam ❑Palbe Rakdlne ❑Fug Re**n <br />true. A wrds Faciiy (w Gemmed MmdfaclRolamnm Numbal: 1 <br />U.G.EPAID combat <br />ay <br />LL <br />Fedlirys Phone: <br />IBa Slgnalum al Allomale Family (a Generator) ' Month Day Year <br />N19. <br />Hazardous WdnlB Repot Nenegemenl Method Code, l.e., codes for hecardauswaste Ueahnent, disposal, raw nownusynems) <br />1 2. 3 4. <br />H341 H141 <br />20. Designated Father or Operator. Ccrefialondr ipl of hazardous mderiabmva,ed by IN mongael complete noted In gam 18a <br />, <br />painted(T) Signature Month Day Yep <br />(G <br />FPA <br />cram aenn.Yl re.,.. a no e,...v...._..am___ D <br />_.., _.__ _- , . ....,,,, DESIGNATED FACILITYI"ENERATOR STATE (IF REQUIRED) <br />1)0014311 2) 0014941 3> 4) <br />