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SSL SK SHIP# __3359522 <br />UNIFORM HAZARDOUS 11' Oenerabr 10 Number r <br />WASTE MANIFEST CAH111003044 2. Pag11 <br />r. Genereta's Name aM Magin Address <br />San Joaquin dOunty Public YOrkS Solid waste <br />7850 R n HridyeFord St <br />Stockton <br />onerelas Phone : <br />559-972-7690 CA 95206-3939 <br />WPKI-? t SYSTEMS, INC. <br />IIIIIIIIII�IIII�IIIIIIIIIIIIIIIII�II \ <br />00435130jif: <br />TXROOOO81205 <br />Faaliys Phone: 510-795-4400 ncM"MR CA 94560 <br />9a. <br />9b. U. S. DOT DeimO n(iceWing Proper Shipping Name, Heard Class, ID Number, CA0980887418 <br />HM and PxRjrtg Group (if any)) 10. Containers <br />NDN RCRA HAZARDOUS WASTE,LIi No, iYPe 11, Total 12unil <br />QuantityWINoI. 13. Waste Dodge <br />ETHYLENE GLYCOL SOLUTION (LESS THAN 50%) TT G 133 <br />2. --IS <br />)651/150163 ' ._,_..'.. vLZOIUlNAI to hAiii I Y IU UESI INATIUN STATE (IF REQUIRED) <br />_• .-•.q,N.b ��uwrs anogoonwn0l mfonratlon D:E 64013629I1 1 <br />SA33073 201427 <br />C30:60 <br />24 HR EMERGENCY <br />SK AUTHORIZED TO#RETAAIN6ASUBSEQUENT <br />LICENSED CARRIERS AS NECESSARY <br />15. <br />GENERATOR'S/OFFEROR'S CERTIFICATION: I hereby dectare that the ccnx of This consignment are fully and accurately described above by the proper shipping name, ani ere aessified, packaged <br />marked and IabeleNplacarded, and are in all respects in proper condition for transport according to applicable Intemationeland <br />national govemmental regulations. If ex <br />Exporter, I Mif" that N contents of this mreifimni conform to the farms of the attached EPA Acknowledgment of Consent. Por shipment aM em the Primary <br />I cedry that the waste minimization statement identified in 40 CFR 26227(a) if I am a large quantity generates) or (b) (it I am a small quantify generator) is true. <br />Generstoes/Oflemr's Rinsed/Typed Nam,e, Signs Wre <br />Monts Day Vear <br />J16. <br />_ <br />Intamational Shipments <br />❑Imponta U.S. ❑Export hoxn U.S. <br />Pont envy/exit. <br />Transporter signature (for exports only): Date Iasi U.S.: <br />w <br />1T.Transporter Acknowledgment of Receipt of Mat arms <br />pa <br />Transpormir 1 Pnmedrfyyed Name Signature Month Day Year <br />z <br />/ <br />Q <br />Trunepo lw2 Prinlod/fyped Name Signature <br />9 Month Day ear <br />K <br />f <br />} <br />18. Discrepancy <br />I <br />18a. Discrepancy Indication Space <br />❑ Quantity ❑Type ❑Residue Ll Partial Rejection Repdiat <br />4KFWI <br />44+e4 iD eJLat,.t.. e6 A611i atm$• a 4Z,s I7S3erK <br />Manileat Reference Number <br />106. Alternate Facility (or Generator) <br />J <br />U. S. EPA ID Number <br />U <br />LL <br />Faallys Pri <br />18c. 5gnaNre ofAltemate Fadllry (a Generate) <br />Qw <br />Month Day Year <br />2 <br />y19. <br />Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) <br />G <br />1' 2, 3. 4. <br />20. Designated Faahy Omer a Operator: Certification of receipt of hazardous materials covered by Ne manifest except as noted in Item 18a <br />1 <br />meMot <br />ay YeearP pV <br />:DA <br />Ile) jY <br />>D <br />Cnm PJM 71 /0.... �1�[�ft�. •.i ______�_... <br />)651/150163 ' ._,_..'.. vLZOIUlNAI to hAiii I Y IU UESI INATIUN STATE (IF REQUIRED) <br />