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SSL SK. SHIP# 219415877 111111111111111 III IIIIIII IIID <br /> Please print or type.(Form designed for use on elite(12-pitch)lypewdter.) q O 0 Form Approved,OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number CAD982405351 2.Pa�1 of 31Em�uy Res000se Ph , 4.MaMlsat Tracking umber <br /> WASTE MANIFEST �btl 1�O SKS <br /> 5.Generators Name and Mailing Address Generators Site Address fgdifferent than mailing address) u 1� <br /> Cal-Trans Shop 10- Lodi Cal-Trans Shop 10- Lad: <br /> 1603 S B St 845 E Pine St <br /> STOCKTON CA 95206 <br /> Generators p aPrh_{mCreo:m 209-333-6953 LODI CA 95240-3108 <br /> It TbRFtt Y—Ktr SYSTEMS, INC. U.S.EPA ID Number TXR00008120S <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Faceily Name and She Address SAFETY-KLEEN SYSTEMS, INC U.S.EPA ID Number <br /> 6000 88TH STREET <br /> SACRAMENTO CA 95828 <br /> Facifil es Phone: 916-386-4913 CA0000084517 <br /> go. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,10 Number, I&Coni 11,Trial 12.Unh <br /> HM and Paddrg Group(h any)) No. Type OumIN <br /> Bty Wc1. 13.Waste Corm <br /> 1 NON-RCRA HAZARDOUS WASTE, LIQUID ' OF 0 134 <br /> o (AQUEOUS BRAKE CLEANER) <br /> 4a <br /> z a NON—RCRA HAZARDOUS WASTE, LIQUID I DM <br /> (AQUEOUS PARTS WASHER SOLUTION) <br /> 3. <br /> 4, <br /> 14.Spool Handling lnsuuctians and Additional Information TSD: SCA 70525721 CA37093 201627 C56'23 w <br /> 24 HR EMERGENCY q1-800-468-1760 (SK / TFI) L <br /> AUTH AS "AGENT-FOR" BY GEN TO RETAIN LICENSED SUB CARRIERS AS NECESSARY �J <br /> 15. GENERATOR'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 clessif ed,padaped, <br /> marked and labeledlplararded,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 Pnmary <br /> Exporter,l certify that the contents of this conagnment conform to he terms of the attached EPA Acknowledgment of Consent. <br /> I ceNhj that the waste minimRaWn statement identified in 40 CFR 261(if I am a large quantity gene )or(b)(f I am a small quantity g rator)is We. <br /> 7�7tofsrOBemrs PmltedfTyped Name Sg Mo—o7m <br /> Jk )LSO/� jr) <br /> 1671htemmonal Shipments <br /> ❑Import to U.S. ❑Export from U.S. PorMmhy/exlC <br /> Transporter signature(for exparo mIY1: Date leaving U.S.: <br /> 17 Transporr nm' Inco �Nam of <br /> �lpt ofMalenals Si nature 'ey] �Y/p <br /> a , ^. 9 0 / <br /> core Pr edlTyped Name Signature Month Day Year <br /> C <br /> r <br /> i18.Discrepancy <br /> 18a.Discrepancy Indication Spare ❑ Ournatity ❑TYP ❑Residue ❑portal Rejection ❑Full Rejection <br /> Manhesl Reference Number. <br /> 186 AlternateFacility for Generator) U.S.EPA ID Number <br /> J <br /> U <br /> LL Faciliys Prang: <br /> w 18c.Signature ofAmmate Facility(orGenerator) Month Day Year <br /> Q <br /> Z <br /> H19.Hazardous Waste Report Management Method Codes(i.e..codes ler haurdcus wash treatment,disposal,and recycling systema) <br /> 1. H141 2. H141 a. 4. <br /> 20.Designated Facility Owner or Operator:Codification Mreceiplof hazardous materials covered by the manifest except as noted In hem 18a <br /> lowiledirtyad Namaigna um — ( Month Day Year <br /> C x? ! <br /> EPA FGrr087110-221(Re��1�51 P,(�eyiQugdigOng�r�obsolgfa. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />