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;. SK SHIP# 231566380' <br /> Please print or type. r _ Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page..1 of 3. mer Rgspo se Pho 4.Man <br /> ifest Tracking Number SKS(� <br /> WASTE MANIFEST CAR8a8�►55:1+�1 ate-X8--1��0 �J 7�i 60 V KV <br /> 5.Generator's Name and Mailing Address 771 <br /> Generator's Site Address(if different than mailing address) <br /> , 4514 Auto Plaza Pkwy <br /> TRACY CA 95376-MOO <br /> Generator's Phone: 289-832-f 400 <br /> 6.Trpstp ,Co tpgnam� SYSTEMS INC U.S.EPA ID Number <br /> 1'X RBQ!0081 c$5 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address '3WETY-KLEEN- SYSTEMS, INC. U.S:EPA ID Number <br /> 6000 88TH STREET <br /> SACRAMENTO , GA 958 <br /> X316-386-4913 8 CA0800Qi84517 <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 <br /> HM and Packing Group(if any)) 13.Waste Codes <br /> No. Quantity Wt.Nol. <br /> 1. NDN-RC.RA ,HAZARDOUS WASTE LIQUID f j; 13-4 <br /> o (AQUEOUS PARTS WASHER SKUTION) y <br /> w <br /> z 2. <br /> w <br /> c7 <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional Information SSD a SC'A a3362025 TR3440 7 <br /> 2.. C;SG:24 <br /> " 4H EMENtiENCY#800-468--1760-CH/Sit/TFI-Contract retained by generator confers a envy aLlIthori. y <br /> `pori ir.i.tial transporter t0 add or cub ti gat d .t oT--a,i. t-,:mswi- er - Pri+ .-, <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 Ike Waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or- if I am a small qu ntity generatgr)s true. <br /> Genera ror's Printed/Typed Narne `t Signat P Month Day Year <br /> _j 16.Internationa Shipments � <br /> r <br /> Z LiImport to U.S. Ll Export from U.S. Po of <br /> Transporter signature(for exports only): Dat leaving U.S.: <br /> W 17.TransporterAcKnowledgment 4 Receipt of Mpterials <br /> LLJ <br /> Transporter 1Pr'ted/T ed Name / Signature Month Day Year <br /> O f <br /> CL __ 7 <br /> Transporfierg Printed/Typed-Name Signature Month Day Year <br /> Y � x'ca <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity yp❑T e ❑ <br /> Residue L1 Partial Rejection El Full Rejection <br /> Manif Terence bar: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> V• <br /> LL Facility's Phone: <br /> W 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> a <br /> Z <br /> N19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> w 1 2. 3. 4. <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 16a <br /> Prir)tedR5j igd Name Month Day Year <br /> EPA Form 8700- {{ ev.1 17) Previous editions are obsolete- DESIGNA FACILITY GENERATOR <br /> 1) 14941/1'560 3 <br />