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SSL SK SHIP# 232239651 <br /> 007766572SK.8 <br /> Please print or type. Form Approved,OMB No.2050.0039 <br /> UNIFORM HAZARDOUS 1.Generator lD Number 2.P 1 of 3. A.Manliest irackin Number <br /> GATI�006139f8 �- i�' � 0 0 7 7 6 5 7 2 SKS <br /> WASTE MANIFEST <br /> S.G n to a and d' Generators Si Address if diderent than math ad nese) <br /> � II�V-�L. A TEMS, INC. SAF�TY-I�tEEN �Ys r�M >INC. <br /> PO BOX 555 5050 SALIDA BLVD <br /> SALID CA 95368 <br /> GerneratwsPhare. . .299-545•-1011 9ALII}A CA 45368 <br /> B:fir �onn SYSTEMS INC U.S.EPA ID Number TXROM81 <br /> 7.Transporter 2 Com n Name U.S.EPA ID Number <br /> CLEAhI F#�t�$pRS ENV SVC INC. 1M D0393S2 5 <br /> 8.Designated Facility Name and Site Address SAFETY;KL.EEN SYSTEMS, INC. U.S.EPAID Number <br /> 6000 88TH STREET <br /> SACRAMENTO g CA 95828 <br /> .916-386-4913 CA0000084517 <br /> Facility's Phone: <br /> 9a. 9b.vs.DOT Description(nctuding Proper Shipping Name,Hazard pass,ID Number. 10.Containers it.Total 12,unit <br /> 13.Waste Codes <br /> HM and Packing Group(d any)) No. Type .Quantity Wt.i d <br /> n: <br /> z 2. NON--RCRA# HAZARDOUS WASTE LIQUID DM G #,34'`: <br /> LU <br /> (AQUEOUS PARTS WASHER SO�.UTION) <br /> 4. <br /> 14:Special Handling Instructions and Additional Information TSD i SCA SAS,. CBS: <br /> 24H EMERSENCV#800--468--1760-CH/SK/TFI-Contract retainedby .generator canfer5 agency authori y <br /> an initial transporter to add or *substitute additional. transporters an rjeneratorlsbehalf. <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby dedare that the contents of this consignment aro fully and accirratey desrxiped above by the proper shipping name,atd 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 cerlify that the contents of this consignment conform to the terms of the.aflachad EPAAcknowledgment of Consent, <br /> I caru(y that the waste minimization statement identified in 40 CFR 26227(8)(H I ani a large quantity generator)or(b)101 am Wsmall quantity generator)is We. <br /> Generato.esfOffe s Print yped Name Signature Month Day Year <br /> �—-- <br /> _d 16.IntemaFonalShipments Ei--li <br /> �. LJ Impottto U.S: ❑Export frpn U.s. Pori of entryletot <br /> Transporter signature(for exports only):. Date leaving U.S.: <br /> W17.7ranspo6rAdmorvledgmentofRecelptofMateMis <br /> UJI <br /> Transporter 1 Prin Na signature Month Day Year <br /> 0. <br /> Transporter 2' rmtedffyped nv Sgnatu �� Motes �ay GYew <br /> e <br /> 18.Discrepancy 4J,t <br /> 188.Discrepancy Indication Space i -ity Type ❑Ridua ❑Partial Ra ction <br /> iJ QtlaMf ❑ esjection ❑Full Reject. <br /> Manliest Reference Number: <br /> 18b.Alternate Factidy{or Generator) U.S.EPA I7 Number <br /> ..r <br /> V <br /> .1 Facilitys Phone: <br /> 18c:SgnatureofAdemaWFacility(orGeneratur) Month Day Year <br /> Z <br /> y19.Hazardous (i.e.,no <br /> Waste Report Management Method Codes des for hazardous waste treatment,disposal,and recycling systems), <br /> W .: <br /> 2. 1141, 9: 4. <br /> 20.Designated'Facility Nmr or Operator.Certification of iecet{ifof hazardous materials covered by the manifest except as nded in Item 18a <br /> Prim Name Sig Month Day Year <br /> C, In YU 04(4/1�-�--f vW-CR I rdN I ri ii n' GOA---� I 10 1 �e t2b <br /> EPA o 7 - OJ.r1 ) Pr vious if a o it. 1AESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM!! <br />