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SK SHIP# 219155251 (IIIIII�I�II�III�IIIIIIIIIIIIIIIII'll 0 0 5 3 2 9 2 3 2 S K S Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.,Emergenpy Response Phone 4.Manifest Trockin Number TXR01�00812°`: 00539232 SKS WASTE MANIFEST 5.Generator's Name and Mailing Address Generators Site Address(if different than mailing address) L. 'EMS, INC. AI-E f lt.�EE[a' SYS En1S, ?PtC. r-9 B[?Y 595 5050 SALIDA BLVD Generator's Phone: -cr'S-1011 SAL IDA CA 95368 Company Name 6.Transporter U.S.EPA ID Number 'TEM9, INC. TV-P0a'lO0.g1_!ate. 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address SAFETY-K!.-EEN UT I P U.S.EPA ID Number 6880 SMITH AVI-- NJEWARI! ;10--795-44 10 !CAD9808P741 P Facility's Phone: 9a. 9b.U.S.OOT Description(inducting Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes HM and Packing Group(if any)) No. Type Quantity Wt.Nol. 1. NON;-RCRA HA7PRDOUS WASTE, 1 TQUID o (USED (-.ITL) Z Orb Z 2. W 0 3. 4. 14.SpecialHandling Instructions and Additional Information TSD;EVG -p00-468-1760 !SK / TFT) A`- - ?" BY GEN TO RETAIL! LICENSED SLIH CARR E-- 15. GENERATOR'SIOFFEROR'S CERTIRCATION: I hereby dedare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, marked and labeledlplacarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations.If export shipment and I am the Primary Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgmen;of Co/tent. I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator) (b)V am a small quantity generator)is true. Ge ner r slOfierors Printedfryped Name Signature Month Day Year 16.International Shipments 1- ❑Import to U.S. ❑Export from U.S. Port of entrylexit: Transporter signature(for exports only): ✓ Dato leaving .S.: W 17.Transporter Acknowledgment of Receipt of Materials TransportPdntedlTyped Name Signature 1 Month Day Year N Z Tran iter 2 Printedrryped Name Signature Month Day Year r- 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection Full Rejection Manifest Reference Number. 18b.Altemate Facility(or Generator) U.S.EPA ID Number J_ V W Facility's Phone. W 18c.Signature of Altemate Facility(or Generator) Month Day Year Q Z y19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) C3 1. "7 2. 3. 4. 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifes x as noted in Item 18a Pdd Name _ Signa re Month Day Year lt_IC EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. D SIGNATEgYACILITY TO DESTINAT STATE(IF REQUIRED)