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SSL SK SHIP# 224151127 111111111111111111111111111 IN III I IIII 0 0 6 2 8 5 9 1 7 S K S Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Pae 1 of 3.Emer ency Response Phone 4.Manifest Tracking Number SKS c WASTE MANIFEST CAL000398730 1-,&c1468-1760 06285917 V„V 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) Paradise Point Marina Paradise Point Marina 8095 Rio Blanco Road. 8095 Rio Blanco Rd STOCKTON CA 95219-8703 Ge terator's Phone: 09-952-1000 STOCKTON CA `35219-8703 6.1Yans orter 1 Company Name U.S.EPA ID Number IN ETY-KLEYEN SYSTEMS INC TXR000081205 7.transporter 2 Company Name S.EP I umb Nm�) �kxbLa� 8.Designated Facility Name and Site Address SAFETY-KLEEN SYSTEMS, INC. U.S.EPA ID Number ob 6000 88TH STREET SACRAMENTO , CA 95828 CA0000084517 916-386-4913 Facility's Phone: ga 9b.U.S.DOT Description(includ ng Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit HNI and Packing Group(if any)) No. Type Quantity Wt.Nol. 13.Waste Codes 1NON-NONHAZARDOUS WASTE LIQUID -BFR G 134 0 F (AQUEOUS PARTS WASHER SOLUTION) PjIP Z 2. W C7 3. 4. I 14.Special Handling Instructions and Additional Information TSD:SCA 75526017 PA23059 201749 CSG:23 24 HR EMERGENCY # 800-468-1760(SAFETY-KLEEN) /C' Lf �'�C --3 I C' AUTH AS "AGENT-FOR" 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 classified,packaged. marked and labeled/placarded,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 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 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a small quantity generator)is true. Gen er o slOfferpr's Printed R ed a e Si nature Month Dayla17 Year 9 �� / J 1B.International Shipments ❑Import to U.S. ❑Export from U.S. Port of entrylexit: z Transporter signature(for exports only): Date leaving U.S.: L= 17.Transporter Acknowledgment of Receipt of Materials Transperl�1 Printed/Typ ame Signature, Month Day Ye_ar y QTransport rinte yped Name Signature � Month Day Year 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity El Type E]Residue ❑Partial Rejection Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number J U I Faciliy's Phone' w 18c.;signature of Alternate Facility(or Generator) Month Day Year Q Z y19.H 3zardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) C3 1 H141 z. 3. a. 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noteP in Item 18a Printed/Typed Name Signature Month Day Year 171 E1) 14941PA Form -22 156l.023) Previous editions are obsolete. DESIGNATED FACILITY T6 D TINATION STATE(IF REQUIRED)