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SSL SK SHIP# 213808160 11111111111111111111111111111111111111111 <br /> Please print or type.(Form designed for use on elite(12-pitch)typewriter.) 0 0 4 3 3 4 4 1 6 S K S <br /> Approved.OMB No,2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page t of 3.Erne ency Res se Phone 4.Manifest Trecking Number <br /> WASTE MANIFEST CAD982485351 1 1-80-4�8-1760 10043344 <br /> 16 SKS <br /> 5.Generators Name and Mailing Address Generator's Site Address(if different than mailing address) <br /> Cal—Trans Shop 30— Lodi Cal—Trans Shop 10— Lodi <br /> 1603 S B St 845 E Pine St <br /> Stockton CA 95206 <br /> Generators Phone: 209-333-6953 Lodi CA 95240-3108 <br /> 6.Trans ner 1 Com n Name U.S.EPA 10 Number <br /> SA ETY—fFaL EN SYSTEMS, INC. TXROOOOS120S <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Fadlity Name and Site Address SAFETY—KLEEN SYSTEMS, INC. U.S.EPA ID Number <br /> 6000 BOTH STREET <br /> Fedlity's Phone: SACRAMENTO CA 95828 <br /> 916-386-4913 CA0000084517 <br /> ga, 96.US.DOT Description(Iodudirg Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.UnitHM and Packing Group(if any)) No. Type Quantity WI.No. 13.Waste Codes <br /> t NON—RCRA HAZARDOUS WASTE, LIQUID OF G 134 <br /> o (AQUEOUS BRAKE CLEANER) <br /> 2 DAOUSPRTSDWWASTE,US I DM( QUEAWASHER SOLUTION) G 134 <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional Information TSD:SCR 64460930 CA37093 201435 f_SG:24 f( <br /> 24 HR EMERGENCY p1R-8A00-468-1760 (SAFETY—KLEEN)IN I Cl I U v 9 <br /> SK AUTHORIZED 15. GENERATOR'SIDFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are MIIy and accurately described above by the proper shipping name,and are dassified,packaged, <br /> marked and Iabeledlplacorded,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 /> Exporter,I candy that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. <br /> I certify that the waste minimization statement identified in 40 CFR 26227(a)(g I am a large quantity generator)or(b)(61 am a small quantity generator)is We. <br /> Genemtor's/0"and PdntedRyped Name Month Day Year <br /> h ZG <br /> � i6. tema6one ipments <br /> F_ 11 Import to U.S. ❑Export from U.S. Pod of enaylexA <br /> Transporter signature(for exports only): Date leaving U.S.: <br /> w 17.TrensporterAduroxledgment of Receipt of Materials <br /> K Than spo er vxt^�� <br /> PrintedRyped <br /> JSignature Day Year <br /> IL <br /> = Then der 2 Printedrryped NameIT <br /> Si naNre <br /> Q 9 Month Day Year <br /> K <br /> 4. 18.Discrepancy <br /> 18a.Discrepancy indication Space ❑ Ouantity ❑TYpe ❑Residua ❑PeNei Rejection El Full Rejection <br /> Manifest Reference Number: <br /> 18h.Alternate Fadlity(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> LL Facilays Phone', <br /> far.Signature of Altemale Facility for Generator) <br /> a Monty Day Year <br /> W <br /> 19.Hazardous Waste Report Management McVrod Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 1. <br /> H141 2. Hi41 3 a. <br /> 20.Designated Fadlity Owner or Operator.Certification of receipt of hazardous materials covered by the manifest except ed in Item 18a <br /> 1 P Monty Day <br /> , Year <br /> Jct r <br /> EPA Fo 870a 2(Rev.3-05) Previous editions are obsolete. SIGNATED ACILITYTO DESTINATION STATE(IF FliIF1 D) <br /> 1)14626/150100 2)14941/150135 <br />