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State of California—Environmental Protection Agency 7-185-0 <br />FornwOpr�'oved OMB No. 205070039 [Expires 9-30-99) See Instructions on ba age 6. <br />_-*-'*ease�prmt or type. Form designed for use on elite (12 pawriter. <br />UNIFORM HAZARDOUS 1. Generator's US EPA ID No. Manifest Document No. <br />WASTE MANIFEST CAL'0000-62 6 403 1 <br />3. Generator's Name and Mailing Address ARTI-N BROWER A. Stoke Man <br />4704 FITE CT <br />STOCKTON CA 95205 B. State Genc <br />st j A. Generator's Phone ( 209 946-3748 <br />n <br />Department of Toxic Substances <br />Sacramento, California <br />2. Page 1 Information in the shaded areas <br />is not required by federal law. <br />of <br />st Document Number - - <br />23473012 <br />tors ID <br />c1`15. Transporter 1 Company Name 6. US EPA ID Number C. State Transporter's ID [Reserved.] <br />0 SAt' ETY--KLEE:N SYSTEMS, INC te tG T R5l1 D. Transporters Phone. <br />.O <br />r''a? 7. Transporter 2 Company Name 8. US EPA ID Number E. State Transporter's ID [Re <br />J <br />yam! Vs ed Fo i i Name and Site Address 10. US EPA ID Number <br />Md �Artf� — � EES! SYSTEMS, INC <br />5050 SALIDA BLVD <br />r' W SAL I DA CA 95368 CAT00061396 <br />J <br />Q 11. US DOT Description (including Proper Shipping Name, Hazard Class, and ID Number) <br />U^. <br />USED CLEANING COMPOUNDS,N. 0. I. IJ. N. <br />LIQUID ((VDT USDOT OR USEPA REGULATED) <br />AQUEOUS PARTS WASHER SOLUTION (E. 3#GAL ) <br />o N b. <br />m E <br />v <br />R <br />... <br />G. State Facility's ID <br />A <br />12. Containers <br />6 <br />T <br />c <br />No. <br />Type <br />ado <br />O <br />G <br />$ tote <br />iS4 <br />R <br />O <br />R <br />T <br />LLJ <br />E <br />R <br />LU <br />EPA/Other. <br />d. <br />19. Discrepancy Indication Space <br />Z <br />F <br />A <br />Z <br />EPA/Other <br />C <br />i <br />W <br />L <br />( <br />V <br />EPA/Other. <br />W <br />Ln J. Additional Descriptions for Materials listed Above <br />Z <br />O <br />Ali <br />J <br />Q <br />Z I5. S ecial Honclf n Instructions and Ai <br />EM RGEP�PC�I RESP#E <br />a <br />Z <br />W <br />2 <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 ciossihed, packed, <br />V 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, 1 certify that I have a program in place to reduce t e volume and toxicity of waste generated to the degree I have determined to be economical <br />d practicable and that I have selected the practicable method of treatment, storage, or sposal currently available to me which minimizes the present and future threat to human heals <br />and the environment; OR, if I am a small quantity generator, I have made o gY-4th effort minimize my waste generation and select the best waste management method that <br />ovoilable to me and that I can afford. <br />OPrin Typed Name ? Sign A n A I _ Month�� Day pY <br />Information <br />468-17 <br />K: Handling Codes for Wastes listed Above <br />c. d.. <br />A 941 B C D <br />U <br />F. Transporter's Phone <br />G. State Facility's ID <br />H. Facility's Phone <br />tag 545-1011 <br />12. Containers <br />13. Total <br />Quantity <br />14. Unit <br />Wt/Vol <br />' <br />1. Waste Number:,: <br />No. <br />Type <br />DM <br />u. <br />G <br />$ tote <br />iS4 <br />EPA/Other • ; _ <br />O <br />R <br />T <br />LLJ <br />E <br />R <br />State' <br />EPA/Other. <br />19. Discrepancy Indication Space <br />Z <br />F <br />A <br />State <br />EPA/Other <br />C <br />i <br />L <br />( <br />54dte <br />EPA/Other. <br />K: Handling Codes for Wastes listed Above <br />c. d.. <br />A 941 B C D <br />U <br />Z <br />T <br />Trans porter cknowled ement of I <br />W <br />Printed/Typed ' <br />ce <br />R <br />u. <br />0 <br />18. Transporter 2 Acknowled ement of I <br />Printed/Type `1 -,.Ls..,,, <br />O <br />R <br />T <br />LLJ <br />E <br />R <br />fU <br />19. Discrepancy Indication Space <br />Z <br />F <br />A <br />C <br />i <br />L <br />( <br />20. Fasjibf Owner or O erabr CertiFica <br />Pr' ted/Type Nomey <br />T <br />�_ QAJA <br />UV w— <br />o terials <br />nature Mont Day Y <br />r <br />of Materials <br />Signature Month Day Y <br />receipt of hazardous materials covered by MmoniFest except as noted in Item 9. <br />Signature nth �oyr n <br />DO NOT WRITE BELOW THIS LINE. <br />