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�lIIl���I!!!�Illlllllllll��llll�lll� <br /> Please print or type. O 0 7 Jkn llp iroTi Ngo.2050-0039 i <br /> UNIFORM HAZARDOUS 1.,Generator ID Number 2.Page 1 of 3.Emergency Response Phoma 4.Manifest Tracking Number <br /> WASTE MANIFEST 1007461962 S K S <br /> S.Generatoft Name and Malling Address Genersto s Site Address(if different than mailing address) . <br /> L .,r. 1 r r C f."-'� Y f.t Ff;'!k. C'�r t fac r rr <br /> .� <br /> Generators Phone: <br /> 6.TU.S.EPA:ID Number <br /> r�"ft6{1=�-L��� Cr°!c;t t-*;�-! ��•� t <br /> 7:Transporter Company Name = U.S.EPA ID Number <br /> P",PI1PP,:, 1�141V INC. ;.;,iD03cc stet . <br /> 8.Designated Facility Name and Site Address SAFETYKI_EEN SYSTF ;- U.S.EPA ID Number. <br /> 6000 88TH STREFT + <br /> SnCRAMENTO) , CC 33p <br /> Facility's Phone:. <br /> 98. 9b-U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total i i Unit 13:Waste Codes <br /> HM and Packing Group(deny)) No. ., Type t',ivanfiiq WLNOI: <br /> OF <br /> w <br /> LU <br /> 2 W" 'ItCRR HFIZARDOLI'.. t711: <br /> !npuFo[iS PARTS WSHFR SOLUTT(lhl) <br /> 3. 1 HAZARDOUS W VE LIQUID DF <br /> 1F PAPTS' WASHER SRI UTION) <br /> 4• <br /> 14.Special Handling instructions and Additional Information <br /> 15.. fV$marked and a ged, <br /> GENERATO <br /> fOFFEROR'S GERTfFiCATION: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 /> belediplacarded,and are to all respects in mer condition for transport according to applicable intemationaland national governmental regulations,If export shipment and f am the Primary <br /> Exporter,I certify that the contents of tins consignment confirm to the terms of the attached EPAAcknowledgment of Consent. <br /> I certify that the waste minimization statement identified irt40 CFR 262.27(a)(I l am a large quantity generatn, or(b)(d I am a small quantity generator)is true, <br /> toes/OtfenWsP' a nat Month Day Year <br /> J. 16 ona ipm is <br /> -ElImport to iks. 0 Export from U.S, Poxt of entry/exit: <br /> Transporter signature(for exports only): Date leaving U.S.: <br /> W 17.Transporter Acknowledgment of Receipt of Materials <br /> nen 1 Pdntedtf a Month ay 4 Year <br /> Qa = re �' -1}�t• tj <br /> T nsporter 2 Printedtlyped Name Signa re Monti Day Year <br /> g 70 <br /> 18.Discrepancy 1 <br /> ti��Jll f�I <br /> 18a.Discrepancy Indication Space Quantity ❑Type EResidue ❑Partial Rejection hill Rejection <br /> Manifest Reference Number:. <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> V <br /> Faditys Phone: <br /> 18c.Signature of Xtemats Facility(or Generator) Month Day Year <br /> Q <br /> Z <br /> 19.Hazardous Waste Report Management Method Cases i,e.,codes for hazardous waste treatment,disposal,'and <br /> us { recycling systems) <br /> l� 1 2 4. <br /> ;2ti:Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Itern 18a <br /> ame Sig Month <br /> _ � Y Yew <br /> Z:Q��F�ACLITY <br /> EPA Form 700 22 ev. -17) revious editions are obsolete �TOEPNeAMANfFEST SYSTEM <br /> •:.y f 1"` <br />