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�;)� c;ul�'�} :='i,ac�;i�+1� II'II�IIIIII�III"IIIIIIII�IIII�IIIII 0 0 6 1 0 0 2 6 7 S K S 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.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number ;;,' f-, : 1006100267 SKS WASTE MANIFEST 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) STEMS;, ICS(;, 'J =f� O1. :Jr_35 . F5050 SALIDA BLVD Generator's Phone: r r3-`� �-i 11 �;r f! T T1A CA 95.-JG 6.Transporter 1 Company Name U.S.EPA ID Number 'STEMS INC TXR00 081. ._ 7.Transporter 2 Company Name U.S.EPA ID Number r:l_PF�N KARBOPS ENVIRONMENTAL SERVI ES INC MAD03932 2250 8.Designated Facility Name and Site Address _:}FETY-`Y,LEENY�iTEh1a INCm U.S.EPA ID Number 6Pl00 38TH STREET SACRAMENTO Facility's Phone: 9a 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit HM and Packing Group(if any)) No. Type Quantity W1.,Nol. 13.Waste Codes 1. - ----- - O UJ w 2. RCRA HAZARDOUS WASTE LI12UID � 20� tiUEOUS PART SOLUTION)UTION) iUUMS ,J OF -_ - 4. 14.Special Handling Instructions and Additional Information TSD:SCA ! HR EFI Ia k-t"C 7 3I1 00-4�U8-1750 (,u TF'I? I iQ 22�'l0 I!TL-; f"r f Cft r� LY V r"r t.t l"(' rl CT n,T t ^r�h+^ C[rr� ^r�i'•L?F..C``_' 1r: 15. GEN ERATOR'SIOFFEROR'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. 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 certify 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. Genera r s/Offeror's Printed/Typed Name Sig atur �n� Mon Day Year. ,L,i•P ce 1M�/3 o11� M �2-- J 16.International Shipments H ❑Import to U.S. ❑Export from U.S. Port of entry/exit: Z Transporter signature(for exports only): Date leaving U.S.: Ll 17.Transporter Acknowledgment of Receipt of Materials Tra iter 1 Printed(fyped Name ( Signatur M �ay Y�ar O / e a 6 C W M Tr nsporter 2 Printed/Type a Signatufe Month Day Year 18.Discrepancy 18a.Discrepancy Indication Space El Quantity ❑Type El Residue ❑Partial Rejection El Full Rejection Manifest Reference Number: F- 18b.Alternate Facility(or Generator) U.S.EPA ID Number J L) Facility's Phone: W - 11 18c.Signature of Alternate Facility(or Generator) Month Day Year Q Z N19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) G1 2. 3. 4. ........_ f3 14 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Printed/Typed Name Signature Month Day Year c rpt L o/It� c�,,� G z r EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. ,KyPESIGNATED FACILITYM DES NATION STATE(IF REQUIRED) Page 5