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SSL SK SHIP# 215193159 IIIII 11111111111111111111111111111111 <br /> Please print or type.(Form designed for use on elite(12-pitch)typewriter.) 0 0 4F6 4 roved.OMB No 2050-0039 <br /> UNIFORM HAZARDOUS t.Generator ID Number 2.Pag441 of 3 Em9�g Rps�nse fhprle 4.Man at TrKking Number <br /> WASTE MANIFEST CAD98248S3S1 7 1—bt[) 'ibti--,6U 004634187 SKS <br /> S.Generator's Name and Mailing Address GeneraWs Site Address(if differed then mailing address) <br /> Cal-Trans Shop 10- Lodi Cal-Trans Shap 10- Lodi <br /> 1603 S B St. 845 E Pine St <br /> Stockton CA 95206 <br /> Genemtoys Phone: 209-333-6953 Lodi CA 95240-31 06 <br /> 6.TtypMVoMMreSYSTEMS, INC. U.S.EPA ID Number <br /> TXROOOU81245 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Facility Name and Su, ran SAFETY-KLEEN SYSTEMS, INC U.S.EPA ID Number <br /> .4000 88TH STREET <br /> Facili es Phone: SACRAMENTO CA 95828 <br /> 916-886-4413 CA000008451% <br /> its. 9b.U.S.DOT Description(thduding Proper Shipping Name,Hazard Class,ID Number, 10,Contin 11,Total 12.Unit <br /> HM and Packing Group(N any)) No. Type Quantity MR01. 13,Waste Codes <br /> 1 NON-RCRA HAZARDOUS WASTE, LIQUID OF 6 134 <br /> o (AQUEOUS BRAKE CLEANER) <br /> 4a <br /> w 2 NON-RCRA HAZARDOUS WASTE, LIQUID DM 5 134 <br /> (AQUEOUS PARTS WASHER SOLUTION) / n <br /> 4. <br /> 14.Special Handling instructions and Additional lnfennatian TSD: SCA 6S9S3249 CA37093 20157 CCSSO%:�2(4,� <br /> 24 HR EMERGENCY S1-800-468-1760 (SAFETY-KLEEN) <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION:I hereby declare that me contents of Nis mnsignmenram(u Pwll!cc=tsly described above by the proper shipping name,and are classified,packaged, <br /> marked and labeled/placarded,and are in all respects in proper condi ion for transport according to applicable international and natural governmental regulatrons.ff export shipment and I am the Primary <br /> Exporter,I certify that the contents of this consignment conrorm to the terms of the attached EPA AcknoWedgment of Consent. <br /> I certify that thewaste minimization statement identified In 40 CFR 262.27(x)(rf l em a large quantity generator)or (rf m spimall quanti nerato Issue. <br /> Generoto mes Printed yped Na Si tu Month Day Year <br /> 18. nlemotional Shipments <br /> F El Import to U.S. ❑Export U.S. Port of entry/exg: <br /> = Transporter signature(for exports only): <br /> Data leaving U.S.: <br /> � 17.TransllaterAcknowledgment of Receipt Qatenals <br /> Transports P tedrTyped Name Signature <br /> Month Day Year <br /> g v � <br /> Tmmpo Prin yped Name signature <br /> Mon Day ear <br /> } 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number. <br /> 186.Alternate Fadllty(w Gereratw) U.S.EPA ID Number <br /> U <br /> LL Fadlitys Phone: <br /> N0j 1st Signature MAltemate Fadlly for(Jerreretor) Monty Day Year <br /> Q <br /> 2 <br /> N 19.Hazardous Waste Report Management Method Cedes(i.e.,code <br /> a for hazardous waste treatment,disposal,and recycling systems) <br /> W 1 <br /> H141 z H141 3. 4. <br /> 20.Designated Facility 01neur or Operator:CeN8w8on of receipt of hazardous materials covered by the manifest except as rated in 1 18e <br /> VIII' Printed4yped NameSignature <br /> Mon ! W ear <br /> EPA Form 5700-22(Rev.3-05 Previous ediflon are obsolete. <br /> ].4626/15601? 2)1494't/1S6U23 DESIGN FACILITY TO DESTINATION STATE(IF REQUIRED) <br />