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ShL SK SHIP# 219560686 <br /> Please pant or type.(Form designed fa use on elle(12-pitch)by nter.) Form Approved.OMB No.2050-01139 <br /> UNIFORM HAZARDOUS 1.GeneralmID Number CAL000345875 2.Pag1f of 3fmffW sjtf"M0 -P`iiiiii <br /> 006196392 ng bar <br /> WASTE MANIFEST FLE <br /> 5 ^ neraWs Name and Mailing Address Ganem aSUolxidrees Lp.tleferent than mailin address) <br /> -DESA - Golden Sate i�DESA - Golden Gare <br /> 18501 West Stanford Rd Attn Sa■gel Mr-henry 18501 Stanford Rd <br /> TRACY CA 95377 Attn Safety Sam <br /> 3,enerarors Phi 209-839-3934 TRACY CA 95377-9708 <br /> s - SYSTEMS, INC. US.EPA ID Number TXR000081205 <br /> 11 7_Transporter 2 Company Name _ U.S.EPA ID Number <br /> Designated Faoliry Name and Site Address CLEAN HRUURS ARAGONITE LLC U.S.EPA ID Number <br /> 11600 NORTH APTUS ROAD <br /> ARAGONITE , UT 84029 <br /> 435-884-8100 UTD981552177 <br /> Faoury'a Dare: <br /> 9a 9b.U S.DOTOesanplion(mcludirq Proper Shipping Name,Hazard Cass,ID Number, 10.Could;; am 11.Total 12.Unit 13.Waste Cobes <br /> HM' and Packing Group lit any)1 <br /> No. Type Quantity Wt.No�. <br /> 1. P F003 F005 D001 <br /> o FLAMMAhLE LIQUID N•O•S. (TOLUENE, �o <br /> METHYL ETHYL KETbNE), 4. 1, PG II D005 DIMS 3522 <br /> 2 <br /> c7 <br /> 3 <br /> 14.SpeoalHandling Instructions and Add4onarinfonrai TSD:AG 70692931 AD20196 CSG; <br /> 1)ERG#133• <br /> 24 HR EME3ENCY #1-800-468-1760 (SK I TFI) <br /> SEE ATTACHMENT <br /> 7069'2931 <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the conlena of this consignment are fully and accurately described above by the proper shipping name,and are dassi8ed,packaged, <br /> maned and labeledirlacanded,and are in all respects In proper condition for Mari according to applicable Intemetemal and national govemane don regulaliens.If export shipment and I am Ne Primary <br /> Exporter.I certify that the caneris of this consignmem conform to the terms of to attached EPAAcknowl dgment of Consent. <br /> 1 cartify that the waste minimization statement idegVii in 40 CFR 262,27(a)(if I am a large quantity generator)or(b)('d I am a smaC quanbry 9eneator)is true. <br /> ner,amatorttlOfferoesPrintedrlyped Name Month Wy Year <br /> '8.Mmallonal Sh:pmenls <br /> _ ❑ WU.S <br /> Imrs rt . ❑Export from U.S. Port Ofantrylexit. <br /> Transporter Miniature for exporz only). Date ea&g U.S <br /> '7-ransporler Ackrwwledgment of Recebt of Mali <br /> T 1 PmteNTyped Name ay ear <br /> a � . <br /> N <br /> Truapoder 2 Ponled7Typad Name I rr'graome month y r <br /> K <br /> 4- <br /> 18.Discrepancy <br /> 18a.Olscrepancy Indicallon Space ❑ Duantity ❑Type ❑Residue ❑Partial Rejection ❑Full Re1alion <br /> Manifest Reference Number: <br /> 180.Alternate Facility(or Generdror) J S.EPA ID Number <br /> V <br /> a <br /> do Fadli sPfgae: <br /> w 182. ignatureof Altemek Faciky(a Generator) Mont Oay Yee, <br /> Q <br /> Z <br /> y19.Hazardous Waste Report Management Meprotl Codes n.e.,codas for hezardws waste tmetment,daiii 1,and racrong systems) <br /> 2. a 4 <br /> 0 <br /> 20 Cesignaled Facility Owner or Operator:Certification of receipt of hazardous metenals cnmred by the manifest except as noted in Iter 18a <br /> PnntedRyped Name Signature Month Day year <br /> EP�1f11�aI ..�,�.�IJ 6a0us a he are gbsc)ete/aQr // DESIGNATED FACILITY TO DESTINATION 5TATE(IF REQUIRED) <br />