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OCT-27-2008 18:27 CITY OF LODI 209 333 6710 P.37 <br /> w " <br /> rt <br /> ' lo pdrd or type.(Form designed for use on elite(12 Itch)Wer.) Form Approved.OMB No.2050-0038 <br /> JUNIFORM HAZARDOUS tDanratorlDNumber CAD9836'12601 2.Page Iof 3.Eme%encyResporrsePhone 4./MaanlmotTruckin Number �/ <br /> WASTEMANIFES7 1 1-800-468-1760 001034324 SKS <br /> 5 .Genaralm'a Name and Mail%Address Ganarelofs SNB Address it rillerem than malling address) <br /> CITY OF LODI <br /> 1331 3 HAS LANE ATTN RANDY LhENNY <br /> LODI CA ?5240 <br /> Generalols Phone: 209-j33-6630 <br /> 6'§%Y"41—'TETW%YSTEN,S, INC. U.S.EPA 11)Hinter TXRO00050930 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> e.DeatinateiFacility Name and Site Address SAFETY—KLEEN SYSTEFIS, INC, 000760 U.S,EPA ID Number <br /> 6000 68TH STREET <br /> 6 <br /> 91G—'s66—'4913 SACRAMENTO CA 9582CA0000084517 <br /> PeCili .s Phone: <br /> ga• 9b.U.S.DOT Description(Including Proper Shipping Name,Hazard Class,ID NumbsB 10Containers 11.Total 12,unit 13.Waste Codes <br /> HM and Packing Group(if any)) No. Type Cuanhry WlAbl. <br /> X 1HAZARDOUS WASTE, LIQUID, N- 0, S- DD G D03 132 <br /> ad 9 NA3082 PG III ( DO39) <br /> 2.W <br /> C7 <br /> a <br /> 4. <br /> 14.Special Handling lnsbuctons andAddiumal Intonation SY. 9'RCK#r 1093 M 3013 00 3 6105947 0000 5197 Ob 11 25 <br /> I pCR(i <br /> SK AUT;MORIZED TO RETAIN LICE14SED SUBSEQUENT CARRIERS AS NECESSARY <br /> 15, GENERATORISIOFFEROR'SCERTIFiCATION; INemW dedare that line contems of one consignment are fWty and aeeurelely described above by the properaNppig name,and!are dass]114 psdm*. <br /> 'mAiked,and fabeledtplacarded.and are N all respects In proper condition for lmnapod ateoMing to apptimble ritemabonaland Tonal govemmenHl regulations.If axpod shipment and lam Nie Pdmeiy <br /> Expo�er,IceNfy,thattle contents of this cplml W di <br /> lalgni contoe forme of the attached--cPAAdamwledgment of Cone —7 <br /> I;eeolfylhallhe whsle minimlrallortstatemem iderltifieEin 40 CFR 2ffi27(e)(Nlamalarga quangty ganerata)ar(hJ asmsN quamitygenre101)is we. <br /> Goq'am{6ye(DNemfs PdnlediTyped Name Month Day Year' <br /> 1c)31L�La—g <br /> J 16.InnrnaN al Shipmehs <br /> f- ❑Import to V.S. El Export barn U.S. Port ofenhyleait <br /> = Transporter aignWre(for exports only): Oateteaving U.S•: <br /> w 17.TranspoWAcknowladgmeol ofRecelp(of Materials <br /> Tranaporterl PPName Signature Month Day Year <br /> % <br /> Q Trenspodair2ypa Neme Slgda Mtvdh Day Year <br /> f- <br /> 16.Discrepancy <br /> 16a.Dlsaepaney Ineffmilal Space ❑ quantity ❑Type ❑Residue ❑Partial Rajadion ❑FWI Rejection <br /> Mani%sl.Reference Number: <br /> 1 fib.Alternate FaclIlly(or Generals) U.S.EPA ID Number <br /> J <br /> V <br /> LL Faci lys Phone: <br /> W 1&Signature ofolemate Farlity(or Generator) MOM Day Year <br /> a <br /> x <br /> 19.Hazardous'Nall,Report Menagemenl Melhod 101 (l,e„Codes for hazardous Waste Veshnem,di%posel,and recycling systems) <br /> 1: '(d 141 2- 3. 4. <br /> 20.Designated Fadll nr of Operator.Cer6ficalion of mooch of nazardous materials covered by the msNhGlenoeptes nded in Ilam Ida <br /> Pdnift7y / "gnlure Men OaY ear <br /> �� art <br /> 1)00003 9(R2.M5) PreVaus 13 Opsamobsolete. a ) DESIGNATED FACILITY TO GENERATOR <br /> i <br />