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SK SHIP R 223177888 <br /> Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Gener�tur 10 Number 2.Pag 1 of 3.E�ercY Respa+se Plane 4.Yamifast Tracking Number <br /> WASTE MANIFEST CAL000298,30 1-- o-4 -1760 0063446 0 SKS <br /> 5.Generators Name and Mailing Address Generator's Site Address('rf different than marling address) <br /> Paradise Point Marina <br /> 8095 ns.c Blanco Fid <br /> STOCKTON CA 95219-8703 <br /> Generators Phone: X07- S-2-1000 <br /> 6.Tran r 1 Name U.S.EPA ID Number <br /> GVEW-KLEN SYSTEMS INC TXR0 X0081205 <br /> 7.Transporter 2 Company Name i U.S EPA ID Nwnber <br /> _ 1 _ <br /> 8.Designated Facility Name and Site Address SAFETY--KLEEN SYST ! -ING. U,S.EPA ID Number <br /> 6000 88TH STREET <br /> SACRAMENTO CA 958.28 <br /> 416-386-4913 r Cttuc7t,i�tiswR 1? <br /> Facility's Phone: <br /> 9a. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes <br /> HM and Packing Group(d any)) No. Type Quantity Wt.NoL <br /> 1. NON-RCPA HAZARDOUS WASTE, LIQUID D 134 <br /> o (At' UEDUS TARTS MASHER SOLUTION) � DY'`i /�J <br /> z 2. <br /> Uj <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional Information TSD:$CA 74526167 F AZ'3059 201736 C rG:23 <br /> 24 HR EMERGENCY # 800-468•-I760(SAFETY-KLEEN)- <br /> AtTH AS re t " BY GEN TO RETAINNS CARRIERS' AS INEGESSARY <br /> 15. GENERATOWSIOFFEROWS CERTIFICATION: i hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, <br /> marked and labeled/placarded,and are in all respects in proper condition for transport according to applicable intemauonal and national govemmental regulations.If export shipment and I am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAduvwledgment of Consent <br /> I certify that the waste minimization statement identified in 40 CFR 262:27(a)(if I am a large quaa*generator)or(b)(if I am a small quantity generator)is true. <br /> Generator's/Offerors Phntedfiyped Name Signature Month Day Year <br /> �j 16.In al Shipments r� <br /> r- Import to U.S. LJ Export from U.B. Port of enlrylexit: <br /> Transporter signal!lre(for exports.only): Date leaving U.S.: <br /> W1 i.Trawortgr Acknowledgmwt of Receipt of Materials if <br /> }" Tra er1 PrsriedlTyped�Jame 7 Month Day ear <br /> n <br /> 4 Transporter 2 Pm ante -.4, . r Signature Day Year <br /> Ar <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication SpaceQuanuty ❑Type * El r ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number. <br /> +eb,wiro aeo cac;rn ro c.�whror) U.S-EPA ID Number, <br /> '(S h <br /> Fac ildy's Phone: <br /> LLI190.Signature otAftemate Facility(or Generates) Nlonih Day Year <br /> Z <br /> S219.hazardous Waste Report Management Me�flod Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> WO1. F11�,y 2. 3. 4. <br /> 20, rrated Facility Owner or Operator.Certification of receiptpf.hazardous maWWs,-y-,d by tv m�rpfest exrapt as rioted in Itt>tn 1$a <br /> P YPed Name Month Day Year <br /> EPA F � evious edi ns airb obssfete. <br /> 1.)149'4111'3 r DE Gltt D FACILITY TOGENERATOR <br />