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SSL SK SHIP# 2604%648P <br /> i 0077195276 KS <br /> Please print of type. Form Approved.OMB No.2050.0039 <br /> UNIFORM HAZARDOUS 1 Generator Ip Number cAD981678760 2.Page 1 of .Er �cy e� rs�P n 4.Manifest TracMng Number �[c <br /> WASTE MANlFE5T 00771952.7 V KS <br /> 5, nofato s Name a hi ding A r ss Generato s Site Address of different Ehan mailing address) <br /> oc l tin I' yy Carp Yard <br /> 14465 S Linc(3 St: <br /> STOCKTON CA 9S206-194t <br /> Generators Phone: 209-937--8106 <br /> 6.My$g9 VVBSYSTEMS INC U.S.EPA ID Number w'fXR00008120 <br /> 7.Transporter 2 Company Name <br /> VW J ) U S. P I Numbe <br /> 8.Designated Facility Name and$[to Address SA ETY—KLEEN SYSTEms, 7N+,. U. .EPA IDNumber <br /> ,6000 B8TH STREET <br /> 916-386-11913 <br /> SACRAMENTO CA 95822 <br /> CA000008451) <br /> Facility's Phone: <br /> ga 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers11.Total 12.Unit <br /> H and Packing Group(it any}) 13.Waste Codes <br /> No. Type Quantity wt./Vol <br /> 1NON-RCRA HAZARDOUS WASTE, LIQUID -ffw- G 134 I <br /> O (AQUEOUS FORTS WASHER SOLUTION) '� -0 A f�0 , <br /> ua <br /> 3 <br /> 1. <br /> 1d.SpecialHandlinglnshuctionsand Additional Information TSD; SCA 84330359' ST'37083 202042 CSG: LS <br /> 24H EMEkGEI~ICY6#800--468—]760—(;H/SK/TFI—Con$T'a[t li'etain?t# �fy generator confers aggenvy au�hf�rit <br /> on itritial trans trrter to add or stsbstitt��te additi�+nal •trans porters on enera•tnr's behalf. <br /> 15. GENERATOR'S10FFEROR'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€abeledlplacarded,and are in all respects in proper condition for transport according to opplicahle international and national governmental regulations It export shipment and I am the Pfimary <br /> Exporter,I certify that the contents of this consignment conform to the terms 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 Targe quantity generator)or tb)lift am_.3 small quantity generator)is true. <br /> GeneratarslOfferar's Printed/Typ d Name Signature { <br /> 9 Month Day Year <br /> 18.International Shipments <br /> F ❑Import to U.S. ❑Export from U.S. Port of enWexit _ <br /> z Transporter signature(for exports only): Date leaving U.S.: <br /> IX w 17.Transporter Aclsnontedgment of Receipt of Materials <br /> Tra po r 1 Prinledlfyp me Signature <br /> Month Day Yea <br /> en en C) <br /> Transporter 2 inledlTyped Name Signatur Month pay Year <br /> Of <br /> t— r ecu z <br /> 18 Discrepancy <br /> 18a.Discrepancy Indication Space <br /> ❑ Quantity ❑Type ❑Residue ❑Partial Rejection El Full Rejection <br /> Manifest Reference Number: <br /> 181b.Altemate Facii ty(ok Generator) U S.EPA)D Number <br /> U <br /> Facility's Phone. <br /> LU IBc.Signature ofAltemateFacility(or Generator) Month Day Year <br /> z <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> LLJ <br /> 1. H141 2, 3. 4. <br /> 20.Designated Facility Owner or Operator:Cerliftcation of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Printed ^ Signature Month Day Year <br /> O. <br /> EPIorm8 o Et `-17] Previous editions are obsole e. TSD FACILITY TO EPA's e-MANIFEST SYSTEM <br />