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Fy _ <br /> y� c � <br /> '(Forfn d�Iet3'#ot iise on ebbe 124tch)lypewt(ter.) h • t z;, . <br /> JD�IPOP <br /> F nSlpproved OMB No 2050-0039. <br /> Naz�pl s; #7000610949 2-Page 1 of 3.Emergency Response Phone � 4 Mgrlfest <br /> =SKS <br /> � 911, CA 73376�419, 7 <br /> STEM XNC. U.S.EPAID Nrmd�er TXR00445dt30'' <br /> 7.Traneporter 2 CompanyName U.S.EPA ID Number <br /> De pratedFaalilyNarneandsioeAddreae SAFETY-KL.EEH SYSTEM INC. 000760 U.S.EPA ID Number <br /> 6000 99TH STREET <br /> SIMAHENTO CA 95121 <br /> F Phone: 916-396-4913 CAOOOOO84517 <br /> 96.11.5.DOT Desaipdon Cmdu ft Proper Shippkq Name,Hazard Class,ID Number, 14.Containers 11.7otal 12.Unit <br /> !g Group s!11} No. Type Quantity WI.Nol. 13.Waste Caries <br /> 1NQM RCCA HAZARDOUS IWASTEF LIQUID Y E!€9 Cs M[lA1E 334 . <br /> (AQUEOUS. PARTS MASHER SOLUTION) � <br /> z 2 <br /> LU <br /> s a <br /> 4. <br /> : Man udi"and Additional lnformation SK 3RCi(#108104295 0033446327 0000370102 0706 25 <br /> 8( M-1rkRIZS0TO RE-TAIN LICENSED-SUBSEQUENT CARRI-MM AS NECESSARY <br /> 15: markecUTOR'SIDFFEROR'S CERTIFICATION: I hereby declare tltat the oonEsnte d dYs corWgrment are{ally and W=a*deu r'bed above by the proper shippklg nerrre,and are dessified,pedceged, <br /> marked and ybeledlplacetded,and are all respects In proper conAon for transport wCordfn9 to applicable Ntematio ral and nag"I Vvernmergel regulations.If export shipment and I am the Primary <br /> \ I oei5fy tllad the cori6errls d fHs cornigrarrerrt conform to the hrmrs dtlre atladred EPAAdmoMfor�ient of Catsent, <br /> I that the warts Mian sWerneal idenfiled in 40 CFR 2b2.27(s)of I ei'A large quan*generatr}or(b)Cdr am a smati quarrUty generamr)is hue. <br /> y :! YPad Name �$ ►^ ;` Moth Day Year <br /> —j 16.Irdemstional5hip7rrsMs <br /> L1 import to U.S. ElE�ort ,w from U.S. ,,,Phi d entryfewt <br /> / Date leaving U.S.: <br /> 17.TtaneporWAd wAb#rwd o(Rec*of Materials <br /> TmnspmW 1 P&rkdl'ypedName S" �r Mordh Day Year <br /> ' 3 <br /> Tmnspofter 2 Prkdedffyped Name ,y Signature Month Day Year <br /> 19.Discrepancy <br /> 189.Discrepancy ktdca op Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejedlon <br /> L 196:Agamete F&*ty(or Ger vk4 Manifest Reference Number <br /> U.S.EPA ID Number <br /> ca <br /> Paddy's Phone: <br /> a1Br:53grtebra dAllarevite Fadty(orC,enerator) Month Day Year/ <br /> z f <br /> 19.H-rdorre Waste Report Marsgrr M Method Codes(i.e.,codes for hazardous waste treatment,disposal,and rer"Aft systems) <br /> ul <br /> ' H141 2. T <br /> ` 4. <br /> _._ .. � <br /> 20.Desigrreted Fa ft Owner a Operstor.,Cerlificalw d receipt d hazardous matedals covered by the mardfest except as rated In Run I& <br /> Signature Month Day Year <br /> ( 3M Previous are obsolete. <br /> INN 4) 6ENEFtATDR S INITIAL COPY <br />