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SSL SK SHIP# 219613376 Illll�lli�lll�lllll��ll�l�f III <br /> 0 0 5 5 2 2 3 7 3 S K 6 <br /> Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number CAD981375157 12.Pagtlof 31priaftrgpfifiaer4.Mantlest Tmcklmber <br /> WASTE MANIFEST 10055N378 S K S <br /> 5. Generators Site Address(it different tun mailing address) <br /> 8@0 W Church St # B <br /> STOCKTON 209-464-6590 CA 95203-3206 <br /> Generators Phone: <br /> 6.T8WWT0M**W SYSTEMS, INC. U.S.EPA ID Number TXROOOOS1205 <br /> 7.Transporter 2 Company Name U.S EPA ID Number <br /> 8 Designated FacWty Name and Site Address EtFAN 2500 LOKERNHAM ROAD U.S.EPA 10 Number <br /> BUTTONWILLOW , CA 93206 <br /> 661-762-6200 CAD980675276 <br /> Facility's Phone: <br /> ga 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10,Containers 11.Total 12.Unit <br /> HM <br /> and Padang Group(d any)) T Q�� M.Nol, <br /> 13.Waste Codes <br /> o (ABSbRBENT AND OIL), 4111 <br /> z 2. <br /> W <br /> C7 <br /> 3. <br /> 4. <br /> 14.Special Handling Instnutions and Additional Information ' '1 <br /> 24 HR EMERGENCY #1-800-468-1760 (SK / TF I) r, 3~- <br /> RUTH AS AGENT-FOR BY GEN TO RETAIN LICENSED SUB CARRIERS AS NECESSARY <br /> 15. GENERATOR'SIOFFERDRS CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are dassified,packaged. <br /> marked and laheledlplacarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations,If export shipment and 1 am the Primary <br /> Exporter,I certify that the contents of this consignment o:4*rm to the terms of cite attached EPA Acknowledgment of Consent. <br /> I certify that the waste minimization statemerf identified in 40 CFR 262.27(a)(d I am a large quantity generator) (dl am a small quan' aerator)is true. <br /> Day <br /> "Orri <br /> 5 YP=N �O <br /> ma nal Shipments <br /> 1 ❑Import to U.S. Export from U.S. Port of entry/exit: <br /> Z Transporter signattim(for exports only): Date leaving U.S.: <br /> oe 17.Transporter Adaiawledgment of Receipt of Materials <br /> W T 1 ' L I <br /> all 02) 1S gnaNre !L/ <br /> IL <br /> IL <br /> 7d. <br /> Transpb 2 Pn ,rryped Name Signature Month Day Year <br /> H <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quaff ❑Type ❑Residue ❑Partial Rma. ❑Fuh Rejection <br /> Manifest Reference Number <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> rat Fa ilitys Phone: <br /> W 18c.Signature of Altemate Facility(or Generator) Month Day Year <br /> Z <br /> y19.Hazardous waste Report Management Method Codes(.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> G 1 <br /> 13 <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in hem 18a <br /> Printed/Typed Name Signature Month Day Year <br /> aIiiT^' 07 <br /> ETfgrr3#VWfgy,M us editionsare o etc. DESIGNATED FACILITYTO DESTIN ON STATE(IF REQUIRED) <br />