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0 0 <br />Please print of type, (Form claimed lar use on mdn n 2.6Iohl mm,wme. m <br />z,wavou <br />- ra....... <br />e npproveoUMtl No. 2U500039 <br />US are of lO Num)pr I'..AD98r 510700 2. Pagol of 3.Emerycncy Response Phone 4. Manifest Nomher <br />T r 0 Y r� ') .. r '16 <br />r SKS 1 1' 81 46ti^'l 16(1 V L) .L u, .,.) U l� U a7I�17 <br />Mani Addleas NC Gensrolofs Slle Address IS d'Waronl than maWng address) <br />INE <br />1120 <br />FkIPON, <br />YUP <br />C:A 95363 <br />G,ameweerrad Phorrkr. 22�O V-599-4111 <br />gSN�r le�p"sY I.". "k-Y$j(ms, If4r.. U.S. EPAID Number _(nH000!1 <br />X0930 <br />7. Dampener 2 Company Name U.S. EPA 10 Number <br />6. Deslgnalatl Fadgry Nama 10 5111 Address SAFETY—KLEEN SYSTEMS, INC. 000760 U.S. EPAID Numbor <br />6000 BBTH STREET <br />SACRAMENTO CA 9584.8 <br />916-3136-4913 <br />Faailly's Phono: C:i0000084517 <br />go, <br />9b. US. 007 Description (Wilding PreperShipring Name, Hazard Class, 10 Number, <br />1g.Comtainera <br />HM <br />and PacNnpGroup (deny)) <br />11. Total <br />QuenlWy <br />l2. UNl <br />WUVUw. <br />13 Waste Codas <br />No. <br />Type <br />NON—RCRA HAZRRDOUB WA9TE, LIQUID <br />DM <br />G <br />134 <br />(AQUEOUS IMMERSION CLEANER) <br />v <br />_ <br />w <br />2ilON—RGRA HAZARDOUS WASTE, LIQUID <br />DM <br />6 <br />134 <br />LR <br />(AQUEOUS PARTS WASHER SOLUTION) <br />_J <br />J <br />3. <br />4. <br />14. Special Handing lnmnsdonsamYd Addgionll lNorprom, SK TRCK8110898684 0039874032 0000371458 0940 22 <br />SK =ZED RETAIN LI ENSED BUBI QUENT L'AR ERS A9 NECESSARY <br />15 GENERATOR'SIDFFEROR'SCERTIFICATION: Ihareby doclva Ulat lhh mnlere U lhlsranSIOm nlerofulyandascumleyde=bedabovo bylho pmporshgpingnamr.ardam dossMid,packaged, <br />marked end lohded/plapNaq and ere NalmspKWNpropmnadlsan fwbansladar (ftbepphmUe Nlamelknmlend <br />mllonalgoYemmeMal mpUallwe. If aspenaNpmenlamtlam the Primary <br />I tangy Ihel Da contents of W e mnSignmenl widener to Her OWNS of Die attached EPAAckwa edgmool of Camam. <br />I wAly lard lllnW SW mnlrNzaaen IlammaN identified In 40 CFR 26Z27(a) III l am a large quadiryganaredad or(b)pfd an a em a gY1aWI)is Nm. <br />Oene ofNlM! Pdnled7yped Nemo Slgnalum : ' Month Day Year <br />16. Nlemnlbnsl hjana <br />Impod to US. ❑Espod from U.S. <br />PodalenlryleriW <br />elgnatUra(Ipr weed9 My): <br />Data leaving U.S.: <br />erAduawMgmanl of RemM olMalwlafs <br />I Pnnledl d a Synalure Man'h Day Year <br />rP0MedlfySo <br />off ( <br />ems <br />r0)71we:pxxy <br />Slp re Manlh Day Yeer <br />ncymurindmlmnSpam. <br />❑ Quangn ❑ TYDa Residue ❑ParWal Rejammn ❑fuk <br />Roycgm <br />1hb. Ahamam Faceiny (or Gm`mmom) Manifest Reference Number. <br />U.S. EPA ID Number <br />U <br />LL <br />FacgNs Plane: ' <br />Ps,_ <br />16e.5 .1— olNNmala Fooury to, Genomle) Month Day Year <br />G <br />Z <br />y1e. <br />Hazardous Waste Report Management Method Codes(La..me. for hazardous vest. boll.__ dspasel, and,e�np sysMms) <br />' <br />H141 a H141 3' 4. <br />1 20 SON FodkryD nen mer. CeNWwllon of ra (ha eNaue maledaamvemdhyOle nienlesl coup,mnmstlMlkm leg <br />Pdntedfryped Name <br />/C Slpnolure bald Dey Year <br />PF f9 m 97A9 -s' IWY,, 3 -DW PAYWOUSedi ions are nh,roml, <br />42 vv14Y41'3) --1 4) UtblUNAl to FAOILITY TO GENERATOR STATE (IF REQUIRED] <br />