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SSL ` k SHIP# 224594933 IIIIIIIIIII�II�I'IIIIIIIII��II��I�lll 0 0 6 5 8 1 1 4 6 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 1.Generator ID Number2.Pag@ 1 of 3 Ems y R s grlse 4.Manifest Tracking Number CALOCt03987;3 WASTE MANIFEST 0 '- 1006581146 SKS 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) Paradise Part¢ Marina Paradise Point rlarina 8095 Rio Blanco Road. 8095 Rio Blanco Rd STOCKTON CA 9S2IQ---8703 Generator's Phone: X09--9S2--1000 -ST0r,; T 0 N CA 95'2" .+ - 6 T�po&f9rypanuNarrte SYS1 EM- 1NC U.S.EPA ID Number 0r tt CC TT lK�LLtt�t�Y TXR000081':�+:... 7.Transporter 2 Company Name U.S,EPSVI^ ILn ,� 8.Designated Facility Name and Site Address SAFETY-KLEEN SYSTEM', INC. U.S.EPA ID Number /��1Y) 6000 BOTH STREET SACRAMENTO CA 95828 916-386-491;3i:.A000013?81 4C` i Facility's Phone: 9a 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit HM and Packing Group(if any)) 13.Waste Codes No. Type Quantity Wt.Nol, 1. NON-RCRA HAZARDOUS WASTE, LIQUID ID G 1.34 0 (AQUEOUS PARTS WASHER SOLUTION) 0 z 2. w c� 3. 4. 14.Special Handling Instructions and Additional Information TGD: SCA 7S7803,70 PA23059 20188 CSG23 24 HR EMERGENCY # 800-468--1760(SAF ETY-KLEEN) by 64S-&-71 AUTH AS "AGENT-FOR" BY GEN TO RETAIN LICENSED SUB CARRIERS AS NECESSARY 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. Generator's/Offeror's Pr yped Name Signature Month Day Year J 16.International S ipments U z 1:1 Import to U.S. ❑Export from U.S. Port of entry/exit: Transporter signature(for exports only): Date leaving U.S.: L 17.Transporter Acknowledgment of Receipt of Materials OTrapepeAer 1 Printed) ed Name SignaturMonth Day Year Q Tran rintedi�d Name Signature Month Day Year HfZ7 Ili; 18.Discrepancy 18a.Discrepancy Indication Space El Quantity El Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number J U LL Facility's Phone: w 18c.Signature of Alternate Facility(or Generator) Month Day Year Q z 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 0 1' H141 2. 3. 4. 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Name Signature Month Day 1 Year EPAFgrWfil3q .d 9 Previous editions are obsolete. UESIGNTF_D FACILITY TO UWEAVINATION STATe7fF REQUIRED)