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S{ SHIl 223011553 <br /> Please print or type,(Form designed for use on elite(12-pitch)typewriter,) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1 1.Generator ID Number cr'c 2 Page 1 of 3.Eri envy Response Phone 4 Manifest Tracking Number }/ <br /> WASTE MANIFEST C�AD982485 3,51 1. 1^. £�_-2}£.rfl-17£',£� 10:06136821 SKS <br /> 5.Generators Name and Mailing Address Generators Site Address(it different than mailing address) <br /> Cal-Trans Shop $@'- Lodi Cal--Tt"ane Shop 10- L.Odt <br /> 1603 S .B Si 845 E f'3n� St <br /> STOCKTON ISA 95206 <br /> Generators Phone: 209—:333—'6553 LOM CA 95241 <br /> 6.Trans orter 1 Cam an Name U.S.EPA ID Number <br /> SAPETY-IRTMEN SYSTEMS INC "iXR0000B1203 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> B.Designated Facility Name and Site Address *SAFETY-KLEEN SYSTEMS, INC U.S.EPA ID Number <br /> 6000 88TH STREET <br /> SACRAMENTO , CA 95828 <br /> X16 3(36"-453 3 CA0Cti000Fi451'7 <br /> Facility'sPhone: <br /> ge 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. Type Quantity Wt.Nol. <br /> oe ' 1 NGN-'RC;RA HAZARDOUS WASTE, LIQUID DF 1 13 134 <br /> o (AQUEOUS BRAKE CLEANER) 1 <br /> We <br /> 2!@i9N-RC.RA HAZARDOUS WASTE LIQUIDwP C' 34" I <br /> (AGUEDUS 6"ART§ WASHER ' MUTION) <br /> 3. i. <br /> 4 <br /> 14,special Handling Insimctions and Additional Information "(• q 9C°A 74=0685 CA37093 201731 C86-23 <br /> I <br /> 24 HR EMERGENCY #1--800-468-1760 (SK 1 TFI) f ) �16c,`n <br /> f'r as e —^�. ie Y ii JLf RET91N _7-rill C"f_. ,0-1119 CARRIERS AS NEUFS¢{ <br /> ARY <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 EPAAcknowledgment of Consent. <br /> I comity 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 tore. <br /> Genaratorsleror's Printed l yped Name, Signature Month Day Year <br /> s IdteinahonalShRmanfs <br /> '" +. . > ❑ <br /> hof to 11„S': D Export from U.S Pdm of entrylexi( <br /> ' Transporter signal(for axpoms only) - y Dare leaving US_ . <br /> �' 1�j Tr&y�"3o`helrke)inowledgmdn(dLReeelprrofMalanzis �: f"' - <br /> �,To sporfor 1 Printed yped Name 'Signature Month Day Year <br /> Q Transpq e 2 P ntedRYped Nams Signature / z Month Day Year <br /> 18,Discrepancy <br /> 18a.Discrepancy Indication Space ❑ quantity ❑Type <br /> ❑Residue ❑Pallial Rejection ` ❑Full Rejection <br /> Manifest Reference Number: <br /> 18b Alternate Facility(or GEnerator) " '_` --' •' �_.. .. <br /> JS EPA 10 Number _ <br /> J _ <br /> U <br /> LL Facility's Phone: - - <br /> w 18c.Signature of Alternate Facility(or Generator) .Month Day Year <br /> 4 <br /> Z <br /> N19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems)' <br /> ® 1. 8141 z. 14,141 <br /> 20 Designated Facility Owneror Operator.Certification of receipt of hazardous materials covered by the manifest except as noted in Item 184 <br /> Pritte yped NameSt aNrp, - Month Day Year <br /> Alk <br /> EPA Form 8700 22 R v 3 05) Nevous editions are obsolete DESIGNATED,FACILITY TO GENERATOR <br /> f.)1+in,IG/9.,� 13 s�145141 S:c5t30%'.�3 <br />