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r <br /> eas, -br type.(Form designed for use on elite(12-pitch)typewriter) Form Approved.Ofvffi No.2050-0039 <br /> t.Generator tD Number 2.Pa 1 M 3.Emer envy R sense trgne 4.Manifest Tracking Number <br /> UNIFORM HAZARDOUS «f:3}5�J:2`=; U;?�; 1 �3�)f?� sF i} �-�`sC' 0035'k33183 <br /> WASTE MANIFEST <br /> 5. enerators Nam and Mailing Address Generators Site dress(if diOerent than rrtaiing address) <br /> GAL TRANS DIVISION 1-0, <br /> 1603 <br /> :tJ ; D I.'S110 <br /> 160}3 S 1R1 ST EQUIP VIi1(.; <br /> r:>t•l.iCKTON .,��s:'i <br /> Generator's Phone: Lt• a <br /> U.S_EPA ID Number <br /> r rYn ame T XP0000�a0930 <br /> 5A ET -..EVEN SYSTEMS, 1!°!G`. <br /> 7.Transporter 2 Company Name <br /> U.S.EPA ID Number <br /> &DesignatgdFacility Name She ,ressSAl=1.'I'`i-!<LEI N 5Y5TE!IS. INE. U. 1PAIDNumber <br /> 6000 88TH STREE, <br /> SACRAMENTO CA 9r a82e <br /> 916-386-4913 � (,1000048451:' <br /> FmWs Phom- <br /> 9b.U.S.DOT (induding Proper Shipping Name,Hazard Class,0 Nranber, 10.Containers 11.Total 12.Unit 13.Waste Codes <br /> 9a. <br /> HM aid Paddng Group(d any)) No. Type Quantity Wt.Nol. <br /> ' <br /> t' NON-�RCRA HAZARDOUS WASTE, LIQUID � DH 4.0 8 134 <br /> (AQUEOUS PARTS WASHER SOLUTION) <br /> 2. <br /> 3 <br /> 4: <br /> 14.3pecialHandling I sirta:twsandAdditionalInformation SK St4IRI4203415340 53467823 370035 201114 CS:0:23 <br /> 24HR EMERGE.NCt #1-800--468-1760 (SAFETY-KL.EEN — CONTRACT #94138) <br /> SK <br /> 16. GENERATOR"SIOFFEROR'S CERTIFICATION:1 heretry declare that fha oaitents of tlds t o tu0y and aauro*described above by Ore proper shippng name,and are ctessibed,pEST ragRTE adcsged. <br /> marked and I carded,arab ere in all respects in proper condition for transport according to� Io and national governmental regulations.If export swomenl and I am the PdMfy <br /> Exporter,:I oeridy."tGie conlertts of this wragnment conform to ft demos Of the attached EPAActuwwted rrmrt of Consent <br /> 1 cetily chat lire waste n statoment identified in 4O CFR 262.27(a)(d I am a large qum ty generator)a.(b)(O I am a wo grranti y gena or is g <br /> reMonth Dayear <br /> Nam LL <br /> A vjl <br /> 10.International Shipments. ❑Import to U.S. 0 Export from U.S. Port or !exit: <br /> -- <br /> Transporter signature exports <br /> 17.Transporter mentofReoBiptofMaterials ?: ;- <br /> ransporter 1 1 yped ante r + re y ear <br /> Z ranspoRer P. t yped Nerve nor re n ay ear . <br /> �[ _ t, <br /> 18.Discrepancy . <br /> 18a.Discreparuy Indication Space O cluemvty i Tye ❑Residua ❑Partial Rejection ❑Fvil Rejection <br /> �} Manifest Refereroe Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> is <br /> �a- Faa sPhonb: Month Day Year <br /> -1 ac.Signature-of A ornate Facility(or Generator) <br /> .to.tiazordous Y1 E�pocE MWiagQmsd Method Codas(i.e.,codes for hazardous waste tray .di .>1mI r4cY�9&yam} <br /> 3. 4 <br /> 220:Designa[i FaCt11Y. Risf,.. Gertl6l >iott of reeeig o <br /> ous maledals covered by."man"excepf;az noted in Item 1 <br /> Print Ta-m-- nabrre Month Day Year <br /> EPA Form 8700-22(Rev.3=05.Previous e0ons are obsolete. DESIGNATED FACILITY TO GENERATOR STATE(IF REQUIRED) <br /> b, <br /> 1)14441l15413 <br />