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SSL SK SHIP# 2JP971.648 IIIIIIIIIIIIIIIIIIIIII IIIII III III <br /> Please print or type,(Form designed for use on elite(12-pitch)typewrites) 0 0 5 3 2 9 4 1 4 S K S <br /> Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number CAD982485351 2.Pag1l of 3. a1 (µ1;gFse P17�,O.1 4.Manlfen Tra°kl Num—W <br /> WASTE MANIFEST 0 0 5 3 9 414 SKS <br /> s' arrransAlainpPdress,_ Lodi. GeneralpraSnafr'Van(RaMerenop <br /> 1603 S B S+f1U 8415ErP�TiSneuYSt <br /> 9?�C.Y,TON CA 95206 <br /> Generetors Phone: 209—e33-6953 LODI CA 9540-3108 <br /> 6.T9Rpgar!1 f 4FLTIP11Va SYSTFMS, INC. U.S EPA 10Number TXROOOO812O5 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> .S.Designated Facility Name and Site Address bRl­hIY—KLhLN SYSILMS, TNC, U.S.EPA ID Number <br /> 6000 BETH STREET <br /> SACRAMENTO CA 95828 <br /> 916-386-491.3 � CR00000B4517 <br /> Facile a Phone: <br /> its. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Claes,ID Number, 10.Contairnra <br /> and Packing Group(darty)) 11.Tonal 12.Ung 13,Waste Codes <br /> HM No. Type Quantity WWOI. <br /> T <br /> — WAbIt"AQUEOUS BRAKE CLEANER) C <br /> aq .J <br /> 2 DO 6 13 <br /> (AQUEOUS PARTS WASHER SOZUTION) �f <br /> 4. <br /> 14.§credal Handling Instructions and Additional hdormfion <br /> 24 HR EMERGENCY #1-800-468-1760 (SK / TFI) <br /> laO 11i &4eq;y <br /> RUTH AS "AGENT—FOR" BY GEN TO RETAIN LICENSED SUB CARRIERS AS NECESSARY <br /> 15. GENERATOR'SIOFFEROWS CERTIFICATION: I hereby declare mat the comems or this consignment am fully and Malay described abare by the proper shipping name,and are Wsdrretl,paft*, <br /> marked and lebeledlpaarded,and ata in all respects in proper condkson(a transport aommmg to arnih able mislay.)and national governmental regulations.s export shipment and I am the Primary <br /> Exporter,I amity that the=tents of this consignment conform to the teems 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 quenthl generator)Is We. <br /> Gemarli5sainors ProSigna MOO <br /> Day Year <br /> > i a4 ( G <br /> 16.international Shkp u 10 <br /> 2 ❑Importto U.S. ❑Export ham U. , <br /> S. Pod mryledt <br /> Transporter sgnaNre(for exports only): Data rng U.S.: <br /> 17.T der AcknroNedgnentof Receipt ofMaleriab <br /> TY; po 1 mdadf/fyped e - SignasoMonth, <br /> Pill <br /> TraffsWW2 Pdnled/fyped Neme Signisae Monro y De Year <br /> 1 1e.Discrepancy <br /> 16e.Discrepancy indication Space ❑ Quantity ❑Type El literalism ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number <br /> 18b.Ahemate Facility(or Generator) <br /> 3,EPA ID Number <br /> V y <br /> W Fac3tyrs Phone <br /> Me.Signature of Alternate Facility(or Gerreraler) Monro Day Year <br /> a <br /> z <br /> 1s.Hazardous Waste Report Management Method Codes(i.e.,codas for hazardous waste eealment despair.and recycling simeme) <br /> c 1. H141 2. H141 <br /> 20.Dedgnabd Facility Dmneror Operator Camiation of receipt of hazardous matenals covered by uta manifest exoW ae need in gem Ise <br /> 1 PrM1eMYPed —Year <br /> Signature J ay <br /> j 4fs C /ilC/ �Cl�iLtsos -1,IF fT&A1A2?ft tl %JtT71"f. *W. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />