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I � p�71/ 11111111�111IIIIlMIIIIIIIIIIIIIIIIIIII <br /> ss� 4 !rr SK SHIF10 x+`!53'70 PO--Us"�kVG 0 0 a b 1 z 3 Q a 6 K s <br /> FoPmAroved.OMB No.2050-0036 <br /> Pleeae print or type, Form dealgned for use on 011ie 12 Itch I Owrllsn <br /> 1 onrlretor to Number 2.Peps 1 of 9.Emerggenvy Response Phone a 0 a4 e61 g SKS <br /> UNIFORM HAZARDOUS (rpU983639394 !. 1900-�4bH�17b0 <br /> WARTS MANIFEPT <br /> 5, enoralors Name and Ma Ing Ad roes eneralore 9Ke Address(H dlflerenl Then mellq g e dhas) <br /> S- ocktoli Wesel <br /> 2 73 Loomisa fid CA 9GNS--e010 <br /> 9tac1(ton <br /> Gere dl Ph": 209--946--0674 Num6;r <br /> e. 'renepodar 1 Compran ame TXR000001205 <br /> SAFETY—kTA SY9TEh1S, :CNC. <br /> um er <br /> . oneporler mpanyNAme <br /> U.S.EPAD Number <br /> e,0ealgnete act y emaen Its race SAFETY^-KI-EEN OF CALIFORNIA, INC. <br /> NEWARII((11JTH AVE. CA 94560 <br /> a1.4-7'��--4400 CAA96489741A y <br /> Feallll'a Pnab; I <br /> ae, gb.U.S DOT Deeaiollom(Including Proper Bhlpping Nerve,Hound Clue,ID Number, t0.Conlelners i1,Tolol 12.UnK td,ween Codec <br /> HM and Pecking Oroup(Ii erry)) No, type Quantity wt Nal. ; <br /> a 1'N0I4 RCRA HAZARDOUS WASTE,G.IQUID ��( TT /��� Q 133 <br /> ETHYLENE GLYCOL SOL.UrYON (LE99 THAN SOV <br /> 2 <br /> 5 <br /> 3 MAR 0 3 201 <br /> a <br /> N RON E <br /> pea HaVinp inoructlonsso Iona In rma on .FSO,EVG G55196�i3 67;306X2 241451 C00' 60 <br /> I <br /> 24 H!? EM>rR>3ENCY N 600—Abfl-17hU,(5AF ETY--KLEEN 94136) <br /> -11" q OR' A : I lNre y echro et the contan ,,Ili cone nmen aro lu y an scam ly dee be y the proper eMpphq rums,and en due106d,peakaped, <br /> wrp <br /> I <br /> marked and Wooledolecarded,and groin all roapege in proper oondleon for Innepon eccordlnp to epplkab nlemelfonel and nseonel govommrntal regulation,If 6xparl shipment and I am the Primary <br /> Exporter.I corny Ilial the w Lente orthe conelpnmenl conform to the lerma of the ehached EPAAr;k 1 co". <br /> I cpnly Thal the waste minlrnlxallon statement IdanlPled In 10 CFR 282,27(:)(II am a lerye ouenn 1 o b) I►m a peD pen6rolor}M Irw, <br /> e Oro1 Name pM on ay ear <br /> TUIn1 n ams ono pmen e Import to U.B. ❑Export frau U.B. Port d an*oxlt: <br /> Transporter signature(for exports only); Dale leeving U.8.: <br /> ce 17.Transporter Arxnowledgment of Reaelpt of Meladale <br /> one r I PrIAW(FOW Namo work lboy Year <br /> 44 w krn ro M I I�Z' I/y <br /> Tronepqrtof ame Blpnalure Month Day y4af <br /> 19,Dlec+opancy <br /> lea,plaaapenq Indlntlon$Paco auanUty ❑Type ❑Reeldue ©Partial Rejecllon ❑Full Re)ecdon <br /> OM1 el R <br /> 18b,Allernals Facely(or Ganerator) U.S.EPA ID Number <br /> w FaGlll a Phonn <br /> b. gne Ute Oma e a Or enero rmoo Oey yoor <br /> te.Hazardous Waste Report ManagementMethod Codas Is.,codes for hazardous waste UsEdmonf,cfWoeol,And recycling oyAt"s) <br /> 1. 7. <br /> 20.Reel ndtad Fecflly Owner or Operator,CerUncaUcn of reoelW of howdoue IruteAale wvered by the manNeal except ea nWd N Ilam 4Be <br /> e gn reMonth Day oar <br /> 7— 13 <br /> EPA Form 8700-22(Rd,a-05) Pteyloue a ons are obsolele. OIESIGNATED FACILITY TO DESTINATION STATE(IE REQUIRED) <br /> 1)f,61/15f,0�0 <br /> D00/> 001 XvLq 90 ;PT 1x3 9T01Z/Q-T/Z0 <br />