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SSL SK SHIP# 219560686 Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number CAL000346875 2.lag V of I 3fjn - Nfh1r49 4.MO O J.a° g eeager 0392 FLE WASTE MANIFEST b 5. shame and Mailiig Address Gener f Site Address if different than matlin address) DESA — Golden SateI SA — if Gate 18501 West Stanford Rd Attn Sas el Mchenry 18501 Stanford Rd TRACY CA 95377 Attn Safety Sam Genrxeror6 Phone; 209-839-3934 TRACY CA 95377-97W SYSTEMS, INC. U.S EPA ID Number TXR000081205 7.Transporter 2 Company Name U.S.EPA ID Number It Designated Facility Name and Site Address U.S.EPA ID Number 11600 NORTH APTLIS ROAD ARAGONITE , LIT 84029 435-884-8100 LiTD981552177 Fadi s Phone gs 91h.U.S.DOT Description(including Proper Shipping Name,Hazard Class,10 Number. 10.Containers 11.Total 12.Unit 13.Waste Codes HM and Packing Group(d any)) No. Type Quantity Wt.Nol. o FLRMAMRhiLE LIQUID N.O.S. (TOLUENE, �n I75 SOLIDS CONTAINING UM P F003 F005 DO01 METHYL ETHYL KET�INE); 4 1; PG ii D005 ^ F 13-se- 2, 522. C7 3 14.spedalHandling Instructions and Additional Information TSD:AG 70692931 AD20198 CSG: 1)ERG#133- 24 HR EMERGENCY #1-800-468-1760 (SK t TFI) SEE ATTACHMENT 70692931 15. GENERATOR'SIOFFEROR'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. marked and lebeledlplacarded,and are in all respects in proper condition for transport according to applicable International and national governmental regulations.0 export shipment and I am the Primary Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowedgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262,27(a)(if I am a large geatntiy generator)or(b)(g I am a small quenfity generator)is true. nerato s Printedirrypeo Name Ngnal I Monthay Year zs�►Lra� � � �� 2 J 16.7illemalibnal Shipments ❑Import to U.S. ❑Export from U.S. Port of entry/exiP _ Z Transporter sinature for exports only). Dale leaving U.S.: W nsporter 17.Trani Adutowledgmenl of Receipt of Materials C Tr nen 1 PrinledrTyped Name on ay Year M Q Transporter 2 Printedflyped Name I signature; t ay e C r 18.Discrepancy - 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Refection ❑Full Rejection Manifest Reference Number. 18b.AJtemale Fault(or Generator) U.S.EPA ID Number fU Q u Fadli s Phone, w18c Signature of Alternate Facility(or Generator) Month Day Year R 2 W19.hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) p I 2 3. 4 1 20 Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 1 Be PMtedrryDed Name Signature Month Day Year EPiff""W-n.MMMOUe " s are gbsVe/ai:? // DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED)