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a <br /> rm designed for use on elite(12-Pitch)typewrter.) Form Approved,OMB No.2050.0039 <br /> Please print or type.,(.F.oio.Maniteat Tracking Ndm4er <br /> UNIFORM HAZARDOUS 1'Generator ID Number 2-Page t se <br /> cr�Loaaasa4a z ' -� &a 3053507 <br /> WASTE MANIFEST <br /> -K-11---80a eratmand Mailiog Address Geheretoi s SBeAddress(If d 8�ard than magin9 address) <br /> T(] t 4 STEEL <br /> 3003 E HAMMER LN C� ��z13-�sG! <br /> STOCKTON :.:. <br /> GeneretotsP.hode: 02.09--956•-4751 <br /> U-S.FPA ID Number <br /> s.T �Ycar a "SYSTE118, INC.. 1 TX�:o�t3c35Ug3a <br /> 7.Transporter 2 Company;Name U.S.ERA ID Number <br /> B.Designated FadtiryName'and Site Address SAFETYrKI t EP( SYSTEMS F I��. U•yyjpA}QNdiil6er <br /> b000. BOTH.STREET <br /> SACRAMENTO r. CA'95824 . r •i- <br /> 9�6- 86w4""IAS t:.A0604a(s445 .r <br /> Fadill Is Phone: <br /> 9b.U.S.DOT gescriptlon.(krduding Proper Shipping Name,Hazard Class,ID Number, 10.Carta�ers. :..ft:70181 .12.Unit 13.Waste Codes <br /> HM and Packkm'G�'oupi(rally)) <br /> Q�rd ty y0!N01. <br /> No. Type <br /> 1."h(Rii--CRA' HAZARDOUS WASTE <br /> LI'0L)2p I�i1•, � 2�4' <br /> p tA{)UEt1C(w'F�if7TS WASFEE23 'ff]LUTION) 0. <br /> f <br /> 3. <br /> 4. <br /> 14.Special HandGmj7nsbuciiOPs Add lnF¢mwNon s�`)( : jJ: F# �7 bt�i.�73; { z'. a$l 37' 7 7.`. . ."''2-p. n6...t.IG.; .; <br /> .2_�1 HR, Et't.�ROE Q. # 800-468-17.60(SAFETY-KL I -' 9'4338) <br /> t <br /> aW AllTH-RIZED. TO RVAIF!'LIMNSED SUBS>E(DUT CARRIERS'AS NEEESSARY <br /> 15. GENERATOR S/OFFEROR'S.xERT1FIt A110N;.,1,heretry'dedalh�t tfie mhfertis of this cohsgjpme�d are And Qcmtt?lelydescribed above by the.proQer rsh}p��g rime.ard.are dessl8ed,packaged..'•._- <br /> marked'atjd labe)ed/p>>erarded,aad'e1e ifi dI ratlpa"' .m Pmprar Condlkorl for transport aeGoN .iB app�rabb'kdematoh8)ago naaorei'Rovemmenfaf rogtiia8drs.t)export shipxnarh antli ata the Primary <br /> Exporter;)cer6TyBra[8re'wntanieof9liisconsi§nri.44 niorm'tb'8se`fa<m3bftheattachedE�AAcimotiuledgraerdofCon iiL" for"Is Into <br /> I certify that 8m vrastaar inknlza8on statement ide0tified In 4Q CFR'z622ija)(d I am a large quantity generator)or(b)j81 am a smell gaari8ty .. ) <br /> Sgdalure Year <br /> Generator st08 ,s PdMed/fyp,ad a .,. <br /> 1 16.Intemationd Shlpmaids <br /> to U.S " 15af of entry)eU `w <br /> re <br /> F 0 fm�d . Q from U;5 <br /> 15N aX $e 6a a lei!.rJm .S.: k <br /> �. Transpdtteisl&natuM .. Pod.-rdy): _ <br /> w 17.T porter Ar*nbwdedgmeN of Receipt of.tdatadals; <; :: <br /> Trdri or t Pdhtrxtl� . Name. =., Signe a- Month Day'. Year <br /> O <br /> a Transporter2Pdn yped°N®ms, Majih Devi Year <br /> J. - <br /> F <br /> 18.Discrepancy .. .. <br /> 18a.Discrepancy indfcal on Space Quantity ❑Type ❑Residua ❑Partial Rejecuon ElFuti'Rejgdtbn T <br /> Manifest Reference Number. <br /> 18b.Attemate FacMty(or Generator) U.S EPA.1p Number <br /> '.r <br /> Faality's Phone: " <br /> W 181,S'ignatura ofAltematd Fedity(or Gene ator) Mbnlh Day YrfB"r' <br /> Z <br /> S2 19.Hazardous Waste Report Management Method Codes(i.0.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 4. <br /> 0 1. <br /> H141 2 3 : <br /> 20.Oes Designated FaciBty Owner or Operator.Cediticafwn of receipt of hazardous materials covered by the manifest except' I In gem 1 month Day '•_ Year} <br /> Print '. _•` S na <br /> .1 _ <br /> EPAFo gg77Q�p. (( 33 ).Rieviouseditionsareobsolete. DESIGNATED FACILITY'S CQIo <br />