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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.Peggg 1 of 3,Erne! ncy se pppne 4.Manifest Tracking Number WASTE MANIFEST CAL0003410"2'8 1 1 -z3 Jt/—'irD&j!ef1ne 003054153 SKS 5.Generator's Name and Mailing Address Generator's Site Address if different than mailin address SWISS AMERICAN SAUSAOIE Ctrl s ) 25:1 DARCY PKWY I_AnIPOP CA °75330-8756 Generator's Phone: 209-'1358-9-5,S F s.ra4r?fLOW-Me SYS 7'EMS, INC. U.S.EPA IDNumber 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address r oAFETY-KLEEN 5YS1'EMS, INC. u:9.;EPAlD Number 6000 SETH STREET ;AC RAMENT0 P. 45828 41�ti-Stga--•x•p � I ' Facility's Phone: i:A0000084c 1%r ga, gb.U.S.ED�cdpVonncluding Proper Shipping Name,Hazard Class,ID Number, 10.ContainersHM antl Pack11.Total 12.Unit13.Waste CodesNo. Type Quantity WtNol.1. NONZA 'Lt !i1;:; t A;;TE, LIQUID(At� RT �IR ,,44.R SOLUI'IUN? M 2.M z. Ulu Cib 3, 4. 14.Special Handling Instructors and Additional Information SK SITYPtI207205046 57476Q 'i, 313i3oz 201223 u x9 AUTHORIZED TOGENC "ftE:TA(?P4uICEN0eD(SUFSrOUEfaTPCARRIERSRABTNE NECESSARY 18. GENERATOR'SIOFFEROR'SCERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, marked and labeled/placarded,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 Acknowledgment of Consent. I cedly that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a small quantity generator)is true. nerator's/Q{fe16t' Prinled/Typed Name _ Signs)u Month Day Year � 1 In rnational Shipments - z ❑Import to U.S. ❑Export from U5. Pod of enhy/exit: Transporter signature(for exports only): Date leaving U.S.: W 17.Transporter Acknowledgment of Receipt of Materials K Trans n edRyped a Signatur 00 Month Day Year N f Transporter 2 Pnnb ype Name Signaturei of Month Day Year 18.Discrepancy t8a.Discrepancy Indication Space . ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: r tBh.Alternate Facility(or Generelor) U.S,EPA IDNumber U I Fablity's Phone: Ow 18c.Signature of Alternate Facility for Generator) G Month Day Year Z On 0 19.Hazardous Waste Report Management Method Codes(I.e„codes for hazardous waste treatment,disposal,and recycling Systems) uJi ' H141 2. a. 4. 20.Desi Facility Owner or OpendqL Certification of receipt of hazardous materialscovered by the manifest except as noun Item 18a Pdnl yp Name Signature Month Day Year -.PA Form 1494 0-22(Rev.3-Ob5) Previous editions are obsolete. DESIGNATED FACILITY TO GENERATOR 1?14441l15eJ:3-02.