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5` SK SHIFT# 224054149 <br /> i <br /> ase print or t}a.(Form designed for use on elile)12-pitch)typewriter,) Form Approved.OMS No.2050-0039 <br /> FKTON <br /> DOUS 1 Generetorl�Number 2,Pap91 M 3.E Rqs 4.Manifest61"M <br /> roc n Nu <br /> ANIFEST CAD93364604 1 1 UttU-9hht-116 006 �� ,24 SKS <br /> s Name and Mailing Address Generator's Site AW*(4 different than rnwhng address) <br /> ge Olds GRc Of Stockton <br /> Auto Center Cir <br /> CA 95212-2838 <br /> Generators Phone: 209-9511-2190 <br /> 6.TrarnspMter 5 Com Name U.S.EPA ID Number <br /> St'1FETY'—MEN SYSTEMS INC TY.RO,�9061205 <br /> 7.Transporter 2 Company Name <br /> U.S.EPA ID fearrber <br /> B.Desgnateci Facility Name and Site Address SAFETY— L EN SYSTEMS. Or VS.EPADKN?ft' <br /> 6000 BOTH STREET <br /> SACRAMENTO CA 95828 <br /> 916-386-4913 CAO06C0945t? <br /> Fadilys Phoria: <br /> ga. 9b.U.S.DOT DesaipWri(including Proper Shipping Name,Hazard Class,10 Number, 10.Containers 11.Total 12.Unit 13 waste Codes <br /> HM M'dPang�P(Wany)) No. Type Quantity wtNor <br /> t NON—RCRA HAZARDOUS WASTE, LIQUID a <br /> (AQUEOUS FARTS WASHER SOLUTION) 2 D(y ft <br /> z 2. <br /> 3 <br /> 4. <br /> 14.Special Handling Instructions and Additional Information TSD:SCA 75431588 IIA41233 201751 C-20:23 <br /> 24 HR ECIERGEIACY 0 800-468-176O(SAFETY—KLEEN) i L (-(0,/I ",z <br /> AUTH AS "-CENT— R' BY GEN TO RETAIN LICENSED SUP CARRIERS A. NECESSARY <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION:I hereby declare cwt the contents of this censgmkml are fully and accurately described above by Ire proper shipping name,and are eassrfied.packaged, <br /> marked and labeledlplacarded,and are in all respects in proper oondttion Por transport according to applicable intemaednal and national governmental regulators.a expoh shipment ant I am the Pmrery <br /> Exposer,I certify that the contents of this consignment conform to the temps of the attached EPAAcknowledgmenl of Consent. <br /> I decay trot the waste minimization statement identified in 40 CFR 262.27(a)(N I am a large quantity generator(or(b)(if I am a small quantity generator)is true. <br /> V• CA'"lorsl SPrinte&7 Name Signature A�Q r '[+mss y��� Month Day Year <br /> n t l� (JT►W �1yt[ I 17 <br /> -A 16,Into 1 Ship ❑ <br /> Import to U.S Eapod from U.S. Port of entrylex 1, _ <br /> a Transportersgnahk (for erpodsordy): Date leaving U S. <br /> 17.Transporter Akdvtowledgmerd of Raceipl of Materials <br /> ILLJ <br /> r Tmn T)InntediTypedNa Signa ure r -� Month Day Year <br /> Q 1� 7 <br /> 4 T 2 Rgted4 Name SgnaNre i Month Day Year <br /> fi"F 1- 48.D�eparsY <br /> I 1Ba.Discrepancy Irrdicaam Space ❑0-rdify ❑Type ❑Residue <br /> ❑Partial Rejeccon ❑Full RejecLon <br /> Manifest Reference Number, <br /> 166.Ahemala Facility for Generator) U.S.EPA ID Number <br /> J <br /> 'w U _ <br /> v, w Fadhtys Pfpne <br /> W 1ac.SgnaArreul Alfemale Faditylr Generator) Month Day `lea' <br /> � a <br /> z <br /> 79 Fiazakddus Waele Rrrped Managemem hledpd Codes(i e„codes for hazardous waste Veatmenl,disposal,and recydng systems) <br /> p 1. N141- 2. 3. 4. <br /> WwW FacilityW <br /> Operator Cerfi6cation 0 receipt 0hazardous malenals covered bythe manifest except as nded in Item lea <br /> 12ZO Tyyud Na a kala a Mon h DayYaar <br /> l700-22(RevPravbuseditions are obsolee. DF GN ED FACILITY TO GENERATOR <br />