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-nia—Environmental Protection Agency _ s <br /> ad OMB No.2050-0039(Expires 9-30-99( -v See Instructions on back of a 6. Department of Toxic Substances Control <br /> .Ar type. Form designed for use on elitO(124pitchJ riter.g� g,, Sacramento,California <br /> �UNIFORM HAZARDOUS <br /> 1. tip U$ P c.°�9 V l 6rtfest Docu nt N o 72PagejI fgfnormaetqunrin the Fedeshades resWASTE MANIFEST ;! <br /> .,.b"raW's tAU0 l ss A. State Manifest Document Number <br /> tf dg�a <br /> LODI CA 95240•-4:799 B, State Generators ID <br /> 209 3333500 <br /> in 4. Generator's Phone <br /> CV 5. Transporter 1 Company Name 6. US EPA ID Number C. StateTranspgrters f€7[Reserved J, <br /> 7-7777 <br /> C? SAFETY-•K.LEEN SYSTEMS, INC: :CRO00075,150 <br /> O <br /> D. Transporter's Phony " <br /> O <br /> 7. Transporter 2 Company Name 8. US EPA ID Number E. State Transporter's Ip(Resewed.l <br /> -' F. Transporter's Phone <br /> V 9. Designated Facility Name and Site Address 0 d 07 6 10. US EPA ID Number G. Stat " <br /> Q AFyy^e�,4 88TH <br /> `�stq--KLE_"N 'S�C',d`S` EI'` S, INC- _ <br /> Z 9J+�o O �R t$.S:�.i; xb rt R E E T �* H. Facility's Phone 'g ;} _ <br /> Q �:>s8sr. R�a''�F.NTC CA `;e<4.28 16 386-4913 <br /> u. <br /> y Q12. Containers 13. Total 14. Unit <br /> V 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) No. Type Quantity Wt/Vol I. Waste Number <br /> i <br /> Z US E1) t;WEA€Elie' 4;QIAf'QUWDS, N- 0, I. 5 W. State 134 <br /> LIQUID? (NOT USDOT OR USEPA, REGULATED) DPI G <br /> 3 G AQUEOUS PARTS WASHER SOLUTION ( 8. 3#GAL ) <br /> o N b' State- <br /> co <br /> coo E <br /> v Rf'A/Other <br /> A C. State <br /> o T <br /> w O <br /> R "EPA/Other�• <br /> w d. <br /> State <br /> t— <br /> Z <br /> w <br /> U EPA/Other <br /> J. AdditionalDescriptions for Materials Listed Above K. Handling Codes for Wastes Listed Above <br /> a. 6. <br /> LU <br /> c. d. <br /> -Misep 41T 12606afls 000 <br /> Q <br /> Zj In i parid8\0 o 1n'I60 24 HR ., IF UNDELIVERABLE RETURN TO GENERATOR. <br /> SK CORP AUTHORIZED TO RETAIN LICENSED SUBSEQUENT CARRIERS AS NECESSARY, <br /> Z SKDOT# A: 941 H: C: D; <br /> t— <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by proper shipping name and are classified,packed, <br /> U marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and national government regulations. <br /> If I am a large quantity generator,I certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically <br /> a practicable and that I have selected the practicable method of treatment,storage,or disposal,,earrently available to me which minimizes the present and future threat to human health <br /> N and the environment;OR,if I am a small quantity generator,I have made a good faith art to minimize my waste generation and select the best waste management method that is <br /> 0 available to me and that I can afford. f <br /> r <br /> Printed/ ed me{ t 's/ Signature jri r. Month Day Year <br /> Zvfi bra il+�- � !; C-_�_.we�^.k'"�;, �.»A'; ".- A•' " f-5 c; r_`.. <br /> w T 17. Transporter 1 Acknowledgement of Receipt of erials t <br /> c' Rp w Pnne /Ty ed Name Signature Mh Day <br /> Year <br /> e <br /> w <br /> U- ' 18. Transporter 2 Acknowledgement of Receipt of Materials <br /> R Printed/Typed Name Signature Month Day Year <br /> R <br /> w E <br /> c/Y R <br /> Q <br /> V 19. Discrepancy Indication Space <br /> Z F <br /> — A <br /> C <br /> 1 <br /> L <br /> 1 20. Facility Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. <br /> Printed/Typed Name Signature Month Day Year <br /> S <br /> DO NOT WRITE BELOW THIS LINE. <br /> DTSC 8022A(1/99) Yellow: GENERATOR RETAINS <br /> EPA 8700-22 <br />