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Please print or type. 0 0 7 FotVrove?tJMB t�o.2050-OW9 <br /> UNIFORM HAZARDOUS 1•Generator i0 Number 2.Paged of 3: mew 0 Ptttolr 4.Manffesi re ng Numr ) <br /> WASTE MANIFEST007461 KS <br /> 5.Generators Name and Mailing Address Ganerator's SiteAddress(itdifferentthan mailing.address) <br /> $ Generator's Phone: <br /> fi.Tra i 1 any U.S.EPA ID Nuttier <br /> 7.Transporter2 Cotm�pany.Name U.S.EPA ID Number <br /> ,;!J-1%' r PPV C i t lqt 1-:VC INC. "jq-- - <br /> < ` <br /> 8.Designated Facility Name and Site Address SAI`ETY-FLEEN Sys —I Sz U.S.EPA ID Number <br /> 6000 88TH STREET <br /> SnCRAMENTO 1 'A t.. <br /> ►11UC.~ ,. <br /> Facll s Phone:. <br /> ga. 9b.U DOT Description(including Proper Shipping Name.Hazard Class,ID Number. 10.Containers 11.Total 12 Unit 13,YYast@Codes <br /> HIM ane Packino Group[if any)) <br /> No. Type Quantity MAvol. <br /> Sir} . <br /> .O <br /> W i <br /> 2. NF�j, RCP HAZARDIUS WASTE LIGUID <br /> (F?fK.I m,. PARTS WASHER si31UT3Phl) <br /> i <br /> a. NOW -DORk 14AZARD13US WASTE LIQU1-0 I � A <br /> IAC!L- LIS PARTC 6A'qHF.-.P SONT'I M <br /> 4. <br /> 14.SpecialHandling instructions and Additional Information <br /> 15. GENERATOWS/OFFEROR'S CERYINCATION: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 labeted/placarded,and are in all respects in proper condition for transport according to applicable international and national:govemmental regulations,if export shipment and I am the Primary <br /> Exporter,I certify that the contents of this carisigrimerit conform to the terms of the attached EPAAcknowledgment of Consent: <br /> I ce"that the waste minimization statement identified in 40 CFR 282.27(a)(If f am a large quantity general or{b)(d)am a small quantity generator)is true. <br /> amislgfferors PTIP <br /> nai <br /> J �, ,�-, / I/ Month Day Year. <br /> � - ' 1 f3 <br /> I= import to U.S. Export from U.S, Port of entrylexit: — <br /> _Transporter signature(for exports a1): Date leaving U.S.: -- <br /> W*ftworbarAcknowledgmeritofReceipttffMaters <br /> Pdntedlf a re Month Day� Year <br /> CL jJJ <br /> Z T15nsporter2 PdnW Typed Name Signa m <br /> Month Day Year <br /> 18:Discrepancy <br /> 18a.Discrepancy Indication Space M Quantity E Type M Residue ❑Partial Rejection Full Rejection <br /> Manifest Reference Number. <br /> 18b.Alternate facility(or Generator) U.S.EPA M Number <br /> _J <br /> V <br /> LL Fectiity's•Pfwne: <br /> 1ft Signature of Alternate Fadliy(or Generator) Month Day Year <br /> a <br /> Z <br /> 19.Hazardous Waste Report Management Method.Codes(.e.,codes for hazardous waste treatmeot',disposaI,and recycling systems) <br /> 4. <br /> 4.Designated Facility Owner or Operator:Cerfifica6on of receipt of hazardous materials covered by the manifest except as noted in hem 18a <br /> etre Sign fvlxrth" Day Year <br /> EPA Form 00.22 ev 17) revious-editions are oWle <br /> I 1 i :i:::��DEATED FACILITY TO EPA`s SYSTEM <br />