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SSL SK alp# 221992696 1110110111111111111111111111111 Please print or .(Form ,. o use oh @lite 12-pitch)typewriter.) � 0 5 S 2 2 0 A 4 & K S Form Approved.OMB No.2050-0039 UNIFORM NA7AR00I3S If lNumbar CA(.>?I@1�35r'.,6�,:^ 2.Pagett of 3. {� sa Ql�9)� 4.Man'rfest Trackin Number WASTE MAWW, _ 00552044 SKS 6' /Classic Sales In Generators Site Address(if different than mailing address) 2577 W YcirsesiEe•Ave MANTECA CR 95337--9641 765-69O-0105 s. FkSYSTEMS INCU.S.EPA ID Number TYR4fOOO1 �q 7-Tff-"RCRff#b7TS ENUIRONMENTAI_ SERUTCES TNC U.S.EPA ID Number 8.Designated Faality Name and Site Addressb - PFT^T q _ _ _.. U.S.EPA ID Number 1737 FACT DENNI ST WIL MTWTON , CA 91744 310-6,s5-9996 ^fii)F11:41E,�:'•�i?_,,r:) Facility's Phone: 9a, 91b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit HM and Packing Group(if any)) 13.Waste Codes _ No. Type Quantity Wtivol. p (OT.- FILTERS) RD"tIS - Z 2. W 3. 4. 14.Special Handling Instructions and Additional Information 24 HR EMERGENCY #1-600-466-1760 (SK J TFI) /1 I PUTH AS ''AGENT—FOR" 6Y GEN TO RETAIN LICENSED SUS CARRIERS A3- E55 15. GENERATOR'SIOFFERDR'S CERTIFICATION: I hereby declare that the contents of this consgnment are fully and accurately described above by the proper shipping name,and aretired,packaged, marked and Iabeleciplacarded,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 cemy that the contents of this consignment conform to the terms of the attached EPAAckno vedgment of Consent. I Party that the waste minimization statement identified in 40 CFR 262.27(a)(G I am a large quantify generator)or(b)(GI am a small quantity generator)is true. Generators/OGemes PrintedrTyped New Signature Month Day Year 77 76.International Shipments 2 ❑Import to U.S. ❑Export from U.S. Pad of entry/eft Transporter signature(for exports only): Date leaving U.S.: 17.Trerepodw AcknowledgmentofReceipt ofMatenals Tra der 1 Print (typed Na , O Sig"a Month Day Year aTrans r2P' typed Name afore Month. Day Year 16.Discrepancy 33i 1 / 18a.Discrepancy indication Space ❑ Quantity 1:1 Type El Residue ❑Partial Rejection ❑Full Rejection Manfest Reference Number: 18b.AGemate Fadliy(orGeneratw) � U.S.EPA ID Number U LL Faciliy's Phone: 1&.Signature mf vmmate Faatily(or Genersor) Month Day Year Z W19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treabnent disposal,and recycling systems) D 1 � 2. 3. 4 20.0e E##fnpFtit ',Carkficafion of rewipt of haardous materials covered byft manifest except as noted in Rein Ills _ Signature Month Day Year ate obsolete. Z - _ DESIGNATED FACILITYTO DESTINATION STATE(IF REQUIRED)