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w <br /> SK ';mrP # 2233528. 1 <br /> fease pnnt or type-[Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-[1039 <br /> 1.Ganemla ID Number �,� 2.Page 1 of 3.Errergerwy Response Phone 4.ManlfestTracking Number q �[ <br /> UNIFORM HAZARp0us "1 V L L: ��I " ? 1 SKS N <br /> WASTE MANIFEST <br /> 5 Generators Name and Mailing Address Generators Site Address{if d1lereal than mailing addressy <br /> l - -i- 9to�}ctan <br /> 3261 Huto Cenla-r Gin CA 95212-`E33i] <br /> QN <br /> r"T <br /> rator5Phoneponer I Co: 2409-9r1_2�9D•ransmpany Nome <br /> U S.EPA 1p Number <br /> 7-Transporter 2 Company Name US EPA ID NLrrber <br /> a DesignatedFaahtyName and Site Address 600 BOTH STREET 1 U5 EPA IDNrn6er <br /> SACRAMENTO wA 9S6�R 1 <br /> 91d�36f,--A9i3 <br /> Faralitys Phone: <br /> 9b.U.S.DOT Descrip5al{inducting Proper Shipping Name,Hazard Class,ID Number. 10.Containers 11 Tonal 12.Una 9a. WtNd 13.Waste Codes <br /> HM and Padang GmuP{if any)) No. Type <br /> 1. s.atri-iAlAWDOUS WASTEa LIOUID. <br /> ..:'JEt7VE FART5 WASHER SOLUTION) <br /> 2, <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional Information T _ S-, if r_ [f <br /> 24 HP SMER;EMCY N 600-460 -1760(SAFETY—ki-EEN) <br /> AUTO 1l,, 7-'FQfi" PY' :� Al TO RETAIN <br /> 15. GENERATOR'SIOFFEROR'5 CERTIFICATM: I hereby dedare that the oontents of this consignment are Fully and accurately described above by the proper shipping name•and are classified,parctcaged, <br /> marked and labeledlplacarded,and are in all respects in proper oorldition for transport according to appl'wable international and national governmental reguiaocns.If export shipment and f am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. <br /> i certify mat the waste minimization statement identified in 40 CFR 262.27(a)(41 am a large quantity generator)or(b)(if I am a small quantity generator)is true. <br /> Generalorslofferoes PrintedfTyped Name Signature Month Day Year <br /> 16.International Shipments <br /> ❑lmporl to U.S. LJ Export from U.S. Pot of enfrylezit <br /> Traruparler signature(for exports only)_ Date leaving U.S.' <br /> 17.TranspvrWAdurowledgme+d of Receipt of Materials <br /> Transporter 1 PrmWiTyped Name Signature Month Day Year <br /> i <br /> i <br /> Transporter 2 Pmh9dlTyped Name Signature t Month Day Year <br /> 18.Discrepancy <br /> iaa.Discrepancy Indication Space ❑ Quaritty ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> MtanitnrA Reference Number <br /> tab.Alternate Facility(or Generator) U.S.EPA ID Number <br /> i <br /> Faclkys Phone <br /> 1 Signature of Memate Fad rty{a Generator] Month Day Year <br /> C <br /> 19 Ha¢vd—Waste Report Management Method Codes{i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 1. 2. 3. 4. <br /> 20.Desgnated Facility Owner of OWBW Cwbfc@bon of receipt of hazardous materials covered by the manifest except as noted In Item 1 as <br /> Pr;W'Typed Name Signature Moth Day Year <br /> i <br /> 3AForm5700-22[Rev 3- ) PreviousediboinsareabWete. GENERATOR'S INITIAL COPY <br /> Scanned with CarnScanner <br />