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SK SHIP#I`2191557-04 Sal�1 I llllillllilll llllllllll lllllllllll 0 0 5 3 2 9 2 2 b 5 K$ Please print or type.(Form designed for use on elite(12-pitch)typevrtiter.) Form Approved.OMB No.2050-0039 1.Generator ID Number 2.Page 1 of 3..Emergency Response Phone. 4.Manifest Trackin Number WASTE M UNIFORM MAANIFESTNIFESTS TX R00008 120" 0053 9226 SKS 5.Generators Name and Mailing Address Generator's Site Address{if different than mailing address) ,aAFE Y-KI_EE^! SYSTEMS, INC. FO BOX 555 SAL I DA CR 95368 Generator's Phone: '--1 F1 SAL IDA ---.. _---.-. 6.Tgnspo ltiy'� U.S.EPA€O Number SYSTEMS, INC. 7,Transporter 2 Company Name U.S.EPA ID Number B.Designated Facility Name and Site Address SAFETY—KLEF.N OF CALIFORNIA, INC. U.S.EPA ID Number E88O SMITH AVE. NEFIAF?K CA 94560CAD980887418 v10-795-4400 Facility's Phone: ga 91 U.S.DOT Description(including Proper Shipping Name,Hazard Class.ID Number, 10,Containers 11.Total 12.Unit 13.Waste Codes HM and Packing Group(ifany)) No. Type Quantity WI.1vol. t. ..j -F WASTE,LIDUIID - o "'-!YLENE SLYCOL SOLATION (LESS THAN 50%) 0i z 2. 3, 4, 14.Special Handling Instructions and Additional Information HL r•s('7: ' TSD:E i,"' 24 HR EI7ERISENCY #1-800-468-1?E0 (SK f TEI) 01 Qzz crTst QEF =7p.3 rFj RE ArNi ( rit7ttectn —.ise ^t -P^ 15. GENERATOR'SIOFFEROR'S CERTIFICATION:1 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 labeledlplacarded,and are in all respects in proper condition for transport according to applicable international and naGpnal governmental regulations.If export shipment and I am the Primary Exporter,Ice"that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Con . I rarity that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(dsel a all quantity generator)is true. Generate SIOIFerors Printedr NWe Signature Month Day Year 1 ` ZI Ilse —+ 1 .niema onai Shipments ElImport to U.S. ElExport from U.S. ort of entrylexit: Transporter signature(for exports only): Date leaving U.S.: W 17.Transporter Acknowledgment of Receipt of Materials Transporter PtintedRyped Name Signature Month Day Year N9 o°t 7-1 (© z T-an3po?terTPnntedffyped Name Signature Month Day Year K t- 18.Discrepancy 18a.Discrepancy Indication Space ❑Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejecfion Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number J U LL Facility's Phone: w iBe.Signature ofArtemate Facility(or Generator) Month Day Year z z w19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) W ' � 1 1 2. 3. 4 20.Designated F Owner or rater:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a PrinledfTyped N Signature Month Day Year EPA Form 8700.22(Rev.3-05)Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED)