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I <br /> Please print or type.(Form designed for use on elite(12-pk-h)typewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1 Generator ID Number q 2.Paga 1 of 3,Emer� cyRespo se yti 4.Manifest Tracking Number <br /> L sc, ... 0© r96 SKS <br /> WASTE MANIFEST <br /> 5.Generatcee Nime and Mallin Address r� Generators Site Address(if different than mailing address). <br /> C liUPr111s 1G VTra~:�_ !•';aaflr i ; �1 urUft, 1.0 Uratij-. t'k�tint) <br /> 1603 S Lt St (tf'ohnSTOUTON CA 99206 <br /> aS'C <br /> Generator's Phone: 209-635-6 7 79 TRAM., LA 9E?77--9IL_(; <br /> s.Tarsp51eff-2 P—! aqe ,3Y8TEI1S :INC � U.S.,EPAIDNumber Tx:P�r�40l3fLG <br /> 7.Transporter 2 Company Name U.S.EPA 10 Nu r�ber <br /> S.Designated Facility Name and Site Address Sp,F IT[Y—K E•EN S)'STE:ilvrNC• U.S.EPA ID Number <br /> 6000 88TH -TREE T <br /> SACRAMENTOir1� 75628Faality's Phone: <br /> 9a. 9b.U.S.DDT Description(including Proper Shipping Name,Hazard Class,IO Number, 10 Containers 11.Total 12.Unit <br /> HM and Packing Group(if any)) No. Type Quantity Wf.Nol. 13.Waste Codes <br /> 1. MO?AGR I�r7Af21)t31.1f� 41r'ts i t, LT011I+ Vii"" r_ , ; <br /> a (AG UEOIJS PARTS WASHER SOLUTION) � �X4 <br /> w <br /> c� <br /> 3. <br /> 4, <br />-_ 14.Special Hand1mglnshdonsand Additional Information TS-+: SL:A i �jwi �y:? l�,r: 7!�; � a F •r <br /> 24 RR E1iI RGENCY RI-000-468-1760 (SK J TF.I) {] � <br /> Al TH 1 5 °rACs !'�I =�iF;" :Y GEIS TO RETAIN L.ICENSE0, I.1L1 CA?cFi�FE��: q �� <br /> 15- GEN ERATOR'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 fabeledlplacarded,and are in all respects in proper condition for transport according to applicable international and national govemmental regulations_ff export shipment and I am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAACkrnoWedgment of Consent. <br /> I certify that the waste minimization statement identified in 40 GFR 262.27(a)Cif I am a large quantity generator)or(b)(if I am a small quantity generator)is true. <br /> lienee s/Offeroes PnntedlT <br /> /yped Name Signatu Month Day Year <br /> _r 16.InteMtfonal Shipire F _ <br /> ❑Importt0 U.S. ❑Export from U.S. Part of entrylerat: <br /> Transporter signature(for exports onh); Date leaving U.S.: <br /> 17.Transporter Acd nuwledgment of Receipt of Materials <br /> OTransporter 1 Pnntedlryped Name - Signature ; <br /> � 1A� ^'']� � � g Mofrth Day Yeav <br /> Q er 2 Printed yped Name <br /> Signature <br /> C <br /> Month Day Year <br /> 6``T <br /> 1B.Discrepancy <br /> / <br /> 1 Ba,Oisuepancy Indication Space <br /> ❑ Quantity ❑Type ❑Residue ❑Partial Rejection <br /> 1 ❑Full Rejection <br /> 1 Bb,ARemate FacGty(or'Gencrator) - - - Manifest ReferenceNumber <br /> U.S:EPA ID Number <br /> U <br /> w FaMity's Phone: <br /> 18c.Signature of Aftemate Facility(or Generator) <br /> w <br /> Z Month Day Year <br /> 19-Hazardous'Naste Report Management Method Codes(I-e.,Codes for hazardous waste treatment,disposal,and recycling systems) <br /> 0 1. {'• L 2. 3 <br /> 4. <br /> 20.Designated Fadily Owner or Operator.Certification of receipt of hazardous materials covered by the manifest except as noted in Item lea <br /> P.- yped Name <br /> _' Sigo3Nre <br /> x f f��' Man Da Year <br /> EPAF 87 1 �' <br /> r y�4°�Plhy Previous edipons are obsoler1 1 <br /> DESIGN 0 FACILITY TO GENERATOR <br />