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SSL SK SHIP# c M 1111111IIII IIIIIII11111111111111 <br /> Z2tlx 3 0055236855 K5 <br /> Please print or type.(Form designed for use on elite(12-pitch)typewriter) R�yo� � Form Approved.OMS No,20500039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number CAL000226285 2.Pagt 1 of 31'"I3�rQ"fwzpfm 4.Manifest Traa m Number �( <br /> WASTE MANIFEST 0 0 5 5 3685 SKS <br /> 5. aerator's Time Maili res Generator's Site Address(U different than mailing address) <br /> �on5D�ica to 0Aainer Co <br /> 75 W Valpico Rd <br /> TRACY CA 95376-9129 <br /> 209-836-2151 <br /> GeneralWs Phone:, Neue <br /> 6.Tg�rLrMle SYSTEMS, INC. U.S.EPA Io Number TX R000081205 <br /> 77 Transporter 2 Company Name r U.S.EPA ID Number <br /> [lQsrn hMrfoti �C-(A' (O �ftf �,11 W Zr7x/V <br /> 8,Designated Facility Name and Site Address CLEAN HA BURS AvNAR I Z U A U.S.EPA ID Number <br /> 1340 W LINCOLN ST <br /> , C <br /> 602-258-6155 PHX OCCr+ RZD049318009 <br /> Faaf s Prone: r r ll�� <br /> 9a 9b,U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.-oral 12.Unit 13.Waste Codes <br /> HM and Padang Group Qf any)) No. Type Quantity Wt Nol. <br /> — <br /> HAZARDOUS WTE, SOLIDS, DM 0 P 223 <br /> cc (ABSORBENTS, RAGS, OIL) <br /> i 2 <br /> w <br /> C7 <br /> 3. <br /> 4. <br /> 4. alHanciliginstructions and Additional lnfwmation 71345 STI 5 0099768 CSG: <br /> 24 HR EMERGENCY #1-800-468-1760 (SK / TFI) <br /> AUTH AS "AGENT—FOR" BY GEN TO RETAIN LICENSED SUB CARRIERS AS NECESSARY <br /> 15, GENERATOR'SWFEROR'S CERTIFICATION:I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are Uassili packaged, <br /> marked and Iabeledlplacarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations.H export shipment and I am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terns of line attached EPA Acknowledgment of Consent. <br /> I certify that Ute waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generates)or(b)JWM quan' general lme. <br /> dOffemis Pan Name n e Month Day Year <br /> J alshipmentsi <br /> El Import y _ <br /> Import to S. ❑Exp d from U.S. Port of entrylexit __ -- — <br /> = Transporter signature t1or stills only): Date leaving U.S.. <br /> 17.Transporter Admawledgnnert Of Receipt of Materials <br /> T �rt'1 Printed(Typed Name Sig re Month <br /> 0t{L� 1VI AP�p� <br /> a <br /> Z<� ATaporter 2 Printed/Typed Name Signatu qey Y n <br /> Y <br /> 18.Disuapancy _1 <br /> IBa.Discrepancy Indication Space ❑Quantity Type Residue El Rejection �1 Full Relection <br /> Manifest Reference Number: <br /> 181b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J_ <br /> V <br /> W Facility's Phone. <br /> w 18c.SgnaE of Altemwe Faaliry(oriGenerator) Month Day Year <br /> N19.Hazardous Waste Report Management Method Codes it e.,codes for hazardous waste Uea .disposal,and recyUing systems) <br /> w 1 I'■r 2. 3. 4. <br /> o TfH� <br /> 20.Designated Faoillty Owmer or Operator Certification of moeipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Pnnted7Typed Name c O� Signature M D Year <br /> V�7r <br /> 1F1f7Wfft%%Q"§, aviouseditionsareobsoleill DESIGNATED FACILIT TO DESTINATION STAT (IF REQUIRED) <br />