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787566-I.3 to print a type. (Form designed for use on elite (12 -pitch) typewdtec) 15981031. Forth Approved. OMB No. 2050.0039 UNIFORM HAZARDOUS 1. Generator ID Number 2. Page l of 3. Emergency Response Phone 1 14. MeniestTiacking Number 00 0069511 DAT WASTE MANIFEST CAi411,i OLC)504 2 1,877i 577--2669 5. Generators Name and MAng Address Generators Site Address (if different than making addrsss) SPN )DRWIN CWNTY POIL.IC WORKS DEPP.RT111W SAN 7ORWIN COUNTY POILIC WORKS DEPARTNENT 1RL EAST HAZELTON AVENUE 2327 E. LOVELACE ROAD Generators Phone: STOCKTON CA 95291 12141460-3066 N6tNTLCR CA 45336 (209)(61-3166 B. Transporter 1 Company Name U.S. EPA 10 Number 7. Transporter 2 Company Name U.S. EPA ID Number 4. Designated Facility Name and Site Address U.S. FPA ID Number 6XIN ENVIROMENTAL KGT, LLC DIA PSC ENVIROEftEFAL AV GES L1956 UNITE ROCI( ROAR LCr Factil Is Phone: ItANN40 rflPROVA, CR q k7 12 f q 3- CADC9 DRE14-11133 Be, 96. U.S. DOT Description [including Proper Shipping Name, Hazard Class, 10 Number, 10. Containers11. Total 12. Unit 13, Auto Codes No, Type 11M and Packing Group of any[) Quantity Wt.Nol. UN1950 PEAOSOL� 2.1. DF 6I2 -_-- ,_ - 2' W20 PAINT RELAIED ISRTERIAL 3 PGI1 612 X p ` DI t �b P -- 3' LIN1263 FAINT RLATED PIPTERIAL 3 P6II DOT -SP 1.1624 612 k' j I CIF 500P 4. lFLMILI: SUDS, ORGANIC, H.U.S. (FUSEES) 4.1 KI7. 612 Df lP 14. Special HandlinglnsmnUons and Additional Information W S7CMU2115-II - EKOM0 AEROSOLS, PRINIS, PL (2➢ IE0163591O - ERG(120) LOOSE[PoO OIL IPSE P (3) IEDIR350-00 ERC(1191 LOOSEPACK OIL IASE P (l) S3C'HIIW410 0D ERG(133) FLANIIAILE SOLIDS, LMLL `i(ISTE IS EXEMPT HOUSEHOLD WRRDOUS JPP lafT941i 5. GENERATOR'SIOFFEROR'SCERTIFICATION: 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 Iabeledlplacanted, and are in all respects in proper condition for transport according to applicable international and national governmental regulations. If export shipment and I am the Primary Exporter, I certify that the contents of this consignment conform to Uta terms of the attached EPA Acknowledgment of Consent. 1 certify that the waste minimization statement identified in 40 CFR 262.27(a) (if I am a large quantity generator) or (b) (if I am a smell quantity, generator) Is Ime. sen t eslOBeror Prinle /Typed Name Signature Month Day Year . Intarnatanal Shipments II-�� ❑ Import N U.S, lJ Export from U.S. Pon of enlrylexlb Tmnspoder signature(for ex pods only): Date leaving U.S.: 7, TrenspolterAcknowledgment of Receipt of Metedes o0 l Printed ad:N e Slg Month Day Year VI '. tansporter 2 Printe&T Name Signature nth Day Year 8. Discrepancy Ba: Discrepancy Indication Space ❑ Quentry❑T ypee ❑Residue PediaRejection Full Reln SkkPjb a&-,r/✓V Manifest Number Rumrenee so. Akemale Facility (orGenerator) [e_..UackiV� C h` e7Dt+re { I - U.S. EPA ID Number r ` C q 4 6 V �/�� I .y T�y�/"�� C ) t � VO1 V acllRys Phone: -4K e 1 Be. Signature o(Allemale Facility (or Generator Month Day Year 9, Hazardous Waste RepodManagement Method Codes (i.e., codes forliazardors waste treatment, disposal, and recycling systems) 2. 3. 4. 1 Ceeignaled Facility Owner or Operator: Cedificetan of receiptof hazardous ma:edals covered by the manifest except as noted in Ilam 18a rated,Typed Name Signature Month Day Yew 1_L_L amtl7OU-22 (Rev.3-05) Previous editions am obsolete. DESIGNATED FACILITY TO, DESTINATION STATE (IF REQUIRED)