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46A2 E Form Awroved. OMB No. 2050-0039 EPA Form 8700-22 (Rev. 3 -OV Previous editions are ob e1q. 01.4626/1F V 04 - 2)1.4941- --- IS 3)14311/1S0190 DESIGNATED FACILITYTO UhNhKAIVM M UNIFORM HAZARDOUS 1 1. Generator 11) Number 1. Pati i of 3� ETHU, R efl�Tc _ 4y 1, %j 4. Manifest Tracking Number 70602740959 SKS- WASTE MANIFESTCAD982SO1736 6. Generators Name and Mailing Address Generators Site Address (if different than mailing address) CAL TRANS DIVISION 10 CAL TRANS SHOP 10--• 30110 1603 S P ST 160;3 S B ST STOCKTON CA 95206 Generator's Phone; 209--948---7813 STOCKTON CA, 9S206 2, 4 7 t> 6. T9 U.S. EPA ID Number ,, 9M Mel Ne '1--i Y G T EM -3, 1. N C. 1 X P. () 0 0 01 �; 0 9 123 0 7. Transporter 2 Company Name U.S. EPA ID Number 8. Designated Facility Name and Site Address SAFETY--KLEEN SYSTEMS, INC. U:?.,,ND Number 6000 881H STREET SACRAMENTO CA 95828 916. 386-4913 CIA000008 45 1. Facility's Phone: 1 9a. 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Containers it. Total 12. Unlit 13. Waste Codes No. Type HM and Packing Group (if any)) Quantity Wt.Nol. ce 1- NON-RCRA HAZARDOUS WASTEi LIQUID DF (1 1341 0 (AQUEOUS BRAKE CLEANER) I o NON-RCRA HAZARDOUS WASTE, LIQUID (AOUEOUS PARTS WASHER SOLUTION) DM 16 u 6 134 --- 3. NON-RCRA HA7ARDOU9 WASTE, LIQUID DN 0 1-1 134 (AQUEOUS IMMERSION CLEANER) 4. 14, Special Handling Instructions and Additional Information SK SHIP02063138810 572OB703 370172 eol?,10 CSO:24 ?4 HR EMERUENCY ffl.-EiOO-468-1760 (SAFETY-RLEEN - CONTRACT #?4138) '1K AUTHORIZED 'TO REIAIN LILLNS ED SUBSEOUEN CARRIERS AS NECES2ARY - 15. GENERATOR11OFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the pr 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 ons. port shipment and I am the Primary prppIname, 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 Cl 262.27(a) (if I am a large quantity generator) or (b) (if I am ajs�MW"LquarN g: Generatoesl(��Ws Print ped Name Signature Month Day Year kV1 I I L �-f &- -j , 116. International Shipments ❑ Import to U.S. El Export from U.S. Pod o/exit Transporter signature (for exports only): Date leaving U.S.: LWA- i 17, Transporter Acknowledgment of Receipt of Materials Ij D TransMr I PrinteciffirpeiName Signature Month D Year y 1 Transporter 2 Pdnted[TyPed Name Signature Month Day Year 18. Discrepancy 18a. Discrepancy Indication Space El Quantity ElType El Residue ❑ Partial Rejection E-1 Full Rejection Manifest Reference Number. 18b. Alternate Facility (or Generator) U,S. EPA ID Number LL Facility's Phone: --[�o-n-th 18c. Signature of Alternate Facility (or Generator) Day Year Z 0 r, 19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) LU 1 H141 H141. 3. 1 H 14 1 7- 20. De I nated Facility Owner or Operator: Certification of receipt of hazardous materials covered by the manifest axes clad in Item 18a Print d Signature Z,/ ......... Mon g DaYear EPA Form 8700-22 (Rev. 3 -OV Previous editions are ob e1q. 01.4626/1F V 04 - 2)1.4941- --- IS 3)14311/1S0190 DESIGNATED FACILITYTO UhNhKAIVM M