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s <br />State of Cali fornic—Environmental Protection Agency 7--185-01 <br />Farm Approved OMB No. 2050-0039 (Expires 9.30.99 See Instructions on b age 6. Department of Toxic Substance! <br />Please print or "type. Form designed for use on elite 11 pewriter. 4Sacramento, California <br />C <br />v <br />v <br />n <br />C, <br />W <br />a <br />0 <br />4141 .4 <br />T -4(- <br />m4 <br />r-2 <br />at <br />LOC <br />LL <br />N- <br />N �. <br />Z <br />2 <br />F <br />3 <br />ad <br />LL <br />N <br />Z <br />LL <br />U. <br />Z <br />C <br />CL <br />ul <br />W <br />oc <br />a <br />Z <br />O <br />a <br />Z <br />W <br />2 <br />t— <br />J <br />U <br />J <br />CL <br />V) <br />oe <br />0 <br />r <br />v <br />Z <br />W <br />W <br />W <br />U- <br />0 <br />W <br />N <br />U <br />E4 <br />-.DOPOT WRITE BELOW THIS LINE. / <br />UNIFORM HAZARDOUS <br />1. Generotor's US EPA ID No. Manifest Document No. <br />2. Page 1 <br />Information in the shaded areas <br />IJL?IIJI�10-`3 95 <br />1 <br />is not required by Federal law. <br />WASTE MANIFEST <br />of <br />3. Generator's Name and Mailing Address I� ART I N BROWER <br />A ."State Manifest D6cument Number <br />47 STET <br />2257914 <br />STOCKTON, CA 95205 <br />B','state Generator s Iv'..: <br />4. Generator's Phone ( 209 Cj 46--3748 <br />4, ,:5 <br />5. Transporter 1 Company Name 6. US EPA ID Number <br />C'.t-5tafe Tran}porter's9D fReserved:J <br />SAFETY—KLEE:i SYSTEMS EIS r 1�5r xR 0{}• 0%. Q <br />D ,wTianaporte`r.`s Phone }; <br />_a <br />7. Transporter 2 Company Nome 8. US EPA ID Number <br />E ;Stale Transporter s IDJReserved'.J <br />.11.. ronsporter's,Phone <br />9. Desi noted Facility Name and Site Address :� 10. US EPA ID Number <br />G 'State Facdity s Ip <br />�,.' XPETY—KLEEN SYSTEMS, INC3" <br />� Ci 1 <br />5550 SALIIDA BLVD <br />' <br />H FociliViPhone <br />aALIDA CA 95368 CAT000613968 <br />ay 9 4 <br />11. US DOT Description (including Proper Shipping Name, Hazard Class, and ID Number) <br />12• Containers <br />13. Total <br />Quantity <br />14. Unit <br />Wt/Vol <br />' <br />L. Waste, Number <br />No. <br />Tye <br />a. <br />:State., <br />USED CLEANING COMPOUNDS, N. O. I. B. N. <br />DM <br />0 <br />134 <br />G <br />g� <br />LIQUID (NOT USDOT OR USE;PA REGULATED) <br />EPA/Other,. <br />AQUEOUS PARTS WASHER SOLUTION (S. 3#GAL) <br />G� <br />E <br />N <br />b. <br />.State <br />REPA/Other. <br />T <br />c. <br />(state <br />O <br />R <br />EPA/Other <br />d. <br />State <br />,"EPA/Other' <br />J Additional Deacriptions'for Materi6lsaisted Above. <br />K 'H'andhng.Codes.for Wastes <br />Lilted%Above <br />b. <br />r` <br />f <br />15. Special Handling Instructions and Additional Information 0408 104 438327 00255236c;'5 0002801 301 24 <br />EMERGENCY RHP#800-.468-1760 2 4HR <br />A 941 B C I3 <br />16. GENERATOR'5 CERTIFICATION: I hereby declare that the contents of this consignment are Fully and accurately described above by proper shipping name and are classified, pocked, <br />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 hove a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economical <br />practicable and that I have selected the practicable method of treatment, storage, or disposal currently available to me which minimizes the present and future threat to human heal <br />and the environment; OR, if I am a small quantity generator, I have made a good faitha rt to minimize my waste generation and select the best waste management method that <br />available to me and that 1 can afford. <br />Printed/Typed Name <br />Sig <br />Month Day Y <br />M - eeom-1 <br />T <br />17. Tr Acknowledgement of Receipt of Materials <br />p <br />ted/Typed Na e <br />- <br />ignature <br />4onth Da Y <br />P <br />�" L GUr'GG <br />G <br />0 <br />18. Transporter 2 Acknowledgement of Receipt of Materials <br />K <br />Printed/Typed Name <br />Signature <br />Month Day Y <br />E <br />R <br />19. Discrepancy Indication Space <br />F <br />A <br />C <br />' <br />I <br />L <br />I <br />20. F ci Owner or O erator Certification of receipt ofAaVardous materials <br />cove;4d b this manifest exce t as note in Item 19. <br />T <br />Prin d/T NameSign <br />ure <br />Month Day <br />Yavd,&Q0 <br />Z oy <br />-.DOPOT WRITE BELOW THIS LINE. / <br />