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SSL SK SHIP# 224151127 (V II I'III 1111111111111111 IN 11111111 <br /> 0 0 6 2 8 5 9 1 7 S K S <br /> Please print or type.(Form designed for use on elite(12-pitch)typewriter) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Pae 1 of 3.Emer ency Response Phone 4.Manifest Tracking Number SKS c <br /> WASTE MANIFEST CAL000398730 y 1-890-468-1760 06285917 V„V <br /> 5.Generators Name and Mailing Address Generators Site Address(if different than mailing address) <br /> Paradise Point Marina Paradise Point Marina <br /> 8095 Rio Blanco Road. 8095 Rio Blanco Rd <br /> STOCKTON CA 95219-8703 <br /> Generator's Phone: 209-952-1000 STOCKTON CA 95219-8703 <br /> 6.Trans orter 1 Com an Name U.S.EPA ID Number <br /> ,3 TY-K�.�EN SYSTEMS INC TXR000081"2'05 <br /> 7.1ransporter2 Company Name SEP umb <br /> Q0a) �k�L]4 <br /> 8.Designated Facility Name and Site Address SAFETY-KLEEN SYSTEMS, INC. U.S.EPA ID Number <br /> 6000 88TH STREET <br /> SACRAMENTO , GA 95828 <br /> 916-386-4913 CA0000084517 <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 /> HNI and Packing Group(if any)) No. Type Quantity Wt.Nol. <br /> 0 1-NON-RCRA HAZARDOUS WASTE LIQUID -OFR G 134 <br /> 0 (AQUEOUS PARTS WASHER SOLUTION) <br /> Z 2. <br /> W <br /> ' <br /> 3. <br /> 4. j <br /> f <br /> 14.Special Handling Instructions and Additional Information TSD:SCA 75526017 PA23059 201749 CSG:23 <br /> I <br /> I0 + i <br /> 24 HR EMERGENCY # 800-468-1760(SAFETY-KLEEN) ` c� (c ICS �0 lly <br /> AUTH AS ,r BY GEN TO RETAIN LIrFN-C;FD R115 CARRIERS AS <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 classified,packaged, <br /> 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 <br /> Exporter,I certify 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 262.27(a)(if I am a large quantity generator)or(b)(if I am a small quantity generator)is true. <br /> Gen o slOfferpr's Printed/T ed a e Signatur� < Moo Day Year <br /> / <br /> J 1 .International Shipments Export from U.S. Port of ent /exit: <br /> i� ❑Import to U.S. ❑ ry <br /> Z Transporter signature(for exports only): Date leaving U.S.: <br /> LM 17.Transporter Acknowledgment of Receipt of Materials <br /> of Trans1 <br /> e7 <br /> 1 PrinteclTyp ame^ Signature Month Day Year <br /> r <br /> a �• Z 7 <br /> N <br /> Wyped Name Signature Month Day Year <br /> ation Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> 18b.,Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> LL- Faciliy's Phone: <br /> w 18c.;signature of Alternate Facility(or Generator) Month Day Year <br /> Q <br /> z <br /> N19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> LJJ 1 H141 z. 3. a. <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as not in Item 18a <br /> Printed/Typed Name / _ Signature n /nth Day_ Year <br /> 1 <br /> c <br /> E1) 14941 - 156023) Previous editions are obsolete. DESIGNATED FACILITY T D TINATION STATE(IF REQUIRED) <br />