Laserfiche WebLink
7185—U1 <br /> Please pri t-Qr I pe.(Form designed for use on elite(12-pitch)t-, iter.) Form Approved.OMB No.2050.0039 <br /> UW.ORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 14.M{{a��nlfeat Tracking Number q �r��//��++ <br /> WAB.TEMANIFEST CAL000221947 1 1-8.0 V0-468-1760 05853JL5 SKS <br /> 5.Genewor's Name and Mailing Address Generator's Site Address(if different than mailing address) <br /> IN TERMINAL SVC IN TERMINAL SVCS <br /> 6540 SO AUSTIN RD. 6540 AUSTIN RD <br /> STOCKTON CA 95215 STOCKTON CA" 95215 <br /> Generators Phone: 209-460—.6021 <br /> 6.Trans nor 1 CompanyName U.S.EPA ID Number <br /> SA ETY»KLEEN SYSTEMS, -INC. TXROOODS0930 <br /> 7.Transporter 2 Company Name : U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address3AF1aTX—KL*9EN SYSTEMS, INC. 000760 U.S.EPA ID Number <br /> a0o a8pf-STREET <br /> SAC AME. CA 45828 <br /> 916 .3_$6=49,13,: . � CA00009$4517 <br /> Facild es Phone:_ <br /> ga, 9b U.S.DOT Descnpt6,0(In.ggding Proper Shipping Name,Hazar �•lass,ID Number, 10.Containers 11.Total 12,Unit 13.Waste Codes <br /> HM and Packing Group(it any)) t No. Type Quantity WLNoI. <br /> NON RCRA"f#AZARDOUS WASTE LIVID DN G 343 <br /> ETHYLENE.GLYCOL SOLUTION' . SS THAN 50X}. <br /> LU <br /> s. <br /> 3. <br /> 4• a. r <br /> i <br /> 14iSpecial Handling lnswcbon$and Additional lnfornn on SK .TRCK#108709549.; 0040.37050'4 <br /> SK AUtHORItED T6 RETAIN LICENSED SUBSEQUENT CARRIERS AS!NEC SSARY. <br /> 15. GENE+ fj'SlOFFEROR'S CEfjTIFICATIQN I ftereby declare that the contents of this ognslgnr. ntare Nty and accurately described above by the proper shipping'name,and are classified,packaged, `.. <br /> marKed and Iabeled/placardr�and are fit;all respects in proper conditon for transport according to appl(cable intematf nal grid national governmental regulations.If export shipment and I am the Primary <br /> Exporter,I certify Na!the cobterits of this consignment conform to the terms of the attached EPAAcknoMedgmern of Consent. <br /> t oerhfy.tn4A-.waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(rf I am a small quantity generator)Is true. <br /> . Geperator s%Offeror s.Pdnt9dlTyped Name Signature Month Day Year <br /> / R r <br /> J 16.1 ematrona hipmpn t S 1?ort of en leiat <br /> Import o U.§: . •,,.�. <br /> Transponer slgnature,(for exports only) Dale leaving U.S.; <br /> 17,Transporter Ack QwiedgMnI of Receipt of Materials <br /> Transpo Pdai?HlTyped Name Signature Month Day Year <br /> 1z t <br /> „. <br /> Trandporter 2 Printed yped Name" S Mohth Day Year <br /> t•- <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space O Quantity ❑Type ❑Residue ❑Penial Rejection ❑Full Rejection <br /> Manifest Reference Number. <br /> 18b.Altamate Facility(or Generator) U.S.EPA ID Number <br /> U <br /> LL Fac liths Phono.. <br /> w 18C.Signature of Altemale Faulty(or.Generator) ; Month Day Year <br /> i <br /> 19.Hazaidous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 1' (1141 2. 3 4 <br /> r , <br /> 1 20.Designated Facility Owner or Operator.Certification of receipt of hazardous materials covered by the manifest exceItem 18a <br /> nded in <br /> y N S"na _ Month )Oay ,Year . <br /> EPA 800-22(Rev.3-05) Previous editions are obsolete. DESIGNATEDFACILITY'S COPY <br /> 1.)000.3587 2) 3): �} <br />