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r'; <br /> • r <br /> n112 <br /> p -type( A f (12-pitch) ) Form Ap roved.OMB No.2050-0039 <br /> Please print a Form designed for-use•use on elitetypewfiter. <br /> 1.Generator ID Number 2 Page i of 3:Emergency Res �)se Phone 4.Manliest Tracking Number <br /> UNIFORM HAZARDOUS i (sl_{) )iri)° C74C d ' tQi%Y�` ' -t"of) S"1 � qS _._s <br /> WASTE MANIFEST <br /> 5.Generators Name and MaA ng Address Generabfa Site Address(d ddferant than malting address) <br /> <,ni"K 1 01•# STEEL <br /> GTOrKTONf;r", ._2 80+ <br /> Generatofs Phone. <br /> ,G()Q <br /> U.S.EPA ID Number <br /> 6.Transporter 1 Company Name tF <br /> S:?HET'r Kl_r'_+N SYSTEMS <br /> U.S.FPA ID Number <br /> 7.Transporter 2 Company Name <br /> U.$.jl A.(D Number <br /> B.Designated FscilityNameandSite Address <br /> g FrET•{._lti.FEi�c SYG'fEtlS, L##i, ,`: <br /> 6000E35T1i STR: ET { <br /> SACRAMENTO CA 7(�S828 <br /> L 1 <br /> A0000Co.;3,4 <br /> Fadiit es Phone: <br /> 9a 9b.U.S.DOT Description Onduding Proper SlxppingName,Hazard Glass,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codas <br /> HM and Packing GmW Of any)) No. Type Quantity W Wd. 4 <br /> UM r '34 <br /> •AZilnDOUS WASTE, LT Ul- <br /> o 4CAQUEOUS PARTS WASHER GOL.(.ITI.D11) <br /> z 2. <br /> w <br /> 3. <br /> i <br /> 4. <br /> t <br /> 14.SpeaaiHa m9InstructionsandAdditanallnforma0m c.. ,., r,..r�rtncrra:�r, ccD'rr�rscr-�+ ;;7k)73��. T01. •:ii:'r ('f_i:2:41, <br /> x. 1 <br /> 24 }fl+ ;~11E^n'GEKY P So(%-4.511-•1 60('iAF'El'Y•-K.LEEt4 - 9413D) . � r- <br /> 15. GENERATOR'S/OFFEROR'S CERTIFICATION:I hereby declare thal'the contents of this oonsfgnmant are fully and accurately described ebove by the(roper shipping name,and are da'am til:poi kpged <br /> marked and labeledipl9caided,and are in all respects in proper condition for transport according to apPfimbIG iMamdor mal gird national�vemmehlel regulations O export shipment and lam Ore Primary <br /> Exporter,I certify that the content's of this consignment conform io the terms of the attached EPAAdmowiedgmenl of Consent, generator)N <br /> I certifythat thewaste minimization statement identified in 40 CFR 262.27(x)Of I am a large quantity generator)or(b) Of t am a smd quarft ge ) true. <br /> Month Day: Year.. <br /> Generatofsl0tferors Printed iTyped Na Sgnahre <br /> "� �: <br /> T_j16.International Shipments F tryl <br /> ❑Import to U.S. ❑Fxport from U.5. ' Pod of ar exA <br /> Z Transporter signature(for exports or* Data leaving U.S <br /> W- <br /> 17.TransporterAcknowledgment of Receipt of Materials <br /> TransRorier 1 Rintedlf ed Name Signature Mpolh Qay<- .Yeas. t <br /> O 1 '_i <br /> f Month Day. Year <br /> QT spe er 2 Print ped Name tura <br /> 18.Discrepancy <br /> 18a.Discrepancy Ind caBon Space Quantity <br /> ❑Type ❑Residue ❑PaNal Rejection Futi Re)ec6on <br /> Manifest Reference Number. <br /> 1 Bb.Altemale fadAty{or Generate) U.S.EPA ID Number <br /> tai Ft'r�.'lilyk Phrxi?: a <br /> Month Year',�:; <br /> LO 1 Be.Signature of Alternate Facony or Generator) <br /> a _ <br /> z <br /> 19.Hazardous Waste Report Management Method Codas O.e.,codes for hazardous waste treabnenl,disposal,and recycling systems) <br /> LU l 3 4. Z <br /> 20.Designated Faalfly Owner or Operator:Codification of receipt of hazardous materials covered by the manifest except as nut kn Item 18a <br /> Signature n <br /> Month 9?Y..:.:.Year.;. <br /> Printedityped Name <br /> ez <br /> EPA Form8100-22(Rev 3.05)Previous editions are obsolete. 6eSi HATED FAGILITIF S COPX�.; <br /> 4 9'1.1.,1 GO 1.35 - - f <br />