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SSL SK SHIP# 223352831 �IIIIIIIII'IIIII��I1lI�IIIIIAI�IIIIII <br /> 006353531 SKS <br /> Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number CAD983646092 2.Pagef of 3.fmWV",8sa i a0 4.Manifest Tracking Number SKS WASTE MANIFEST 0 V K V <br /> I.Ggpeeratoar 9Naamedy MSIint dMdrressaf Stockton <br /> Generator's Site Address(if different than mailing address) <br /> 13261 AutoCenterCir <br /> STOCKTON CA 95212-2838 <br /> Generator's Phone: 209-951-2190 <br /> 6.T9Wtrrl#WftEtR SYSTEMS INC U.S.EPA ID Number TXROOOOB1205 <br /> 7.Transporter 2 Company Name UMP r <br /> CLe <br /> 8.Designated Facility Name and Site dress , J.N G. U.S.EPA ID Number <br /> 6000 88TH STREET <br /> SACRAMENTO CA 9582$ <br /> 916-386-4913 CA0000084517 <br /> Facility's Phone: <br /> 9a. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit <br /> HM and Packing Group(if any)) 13.Waste Codes <br /> No. Type Quantity Wt.Nol. <br /> NON-RGRA HAZARDOUS WASTE, LIQUID --u---UT <br /> 0 1 (AQUEOUS PARTS WASHER SOLUTION) <br /> W <br /> Z 2. <br /> LU <br /> 3. <br /> i <br /> 4. <br /> 14.Special Handling Instructions and Additional Information—TSD SCA U6154 nA41233 2 <br /> 24 HR EMERGENCY # 800-468-1760(SAFETY-KLEEN) -1 OL 441—P-73 <br /> AUTH AS °AGENT-FOR" BY GEN TO RETAIN LICENSED SUB CARRIERS AS NECESSARY <br /> 15. GENERATOR'S/OFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, <br /> 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 <br /> Export r,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. <br /> I i a waste inimization st CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a small quantity generator)is true. <br /> Gener rs/ a Nae ff Signatur M th AV7 Year <br /> (CC f— (I] <br /> —J 16.Intemationa Shipments <br /> ZI rt to U.S. ❑Export from U.S. Port of entry/exit: <br /> Transporter signature(for exports only): Date leaving U.S.: <br /> LX 17.Transporter Acknowledgment of Receipt of Materials <br /> O Tra `po�1 Pr nted(f Name y <br /> I l� Signature ) Morth Da Year <br /> a y/ 111,7 <br /> Q Transporter Prin d(fy a Signature Month Day Year <br /> 12-q 11-7 <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space El Quantity ❑Type <br /> ❑Residue ❑Partial Rejection ❑Full Rejection <br /> JZ <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> LL Facility's Phone: <br /> w 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> Q <br /> Z <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 0 1' H141 2. 3. 4. <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> ed NameSi re Month Day Year <br /> EP 2 Previous editions are obsolete. <br /> ��� fiV ' DESIGNA E FACILITY TO DE ATION STATE(IF REQUIRED) <br />