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1234 S62H III11111111111 lllillllll1111111111111 <br /> SSL SK SHIP# ,'_'--�^=��wC� <br /> 0 0 6 3 4 0 6 6 2 S K S <br /> Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number CAL000375509 12.Pag11 of 31M"V5y'P4WgLe1 Fn0 4.Manifest Tracking Number �( <br /> WASTE MANIFEST 1006340662 SKS <br /> 5.Geatpr'ssmeoUn bAQ in Add�esOs Inc. Generator's Site Address(if different than mailing address) <br /> 8830 W Linne Rd <br /> TRACY CA 95304-9109 <br /> Generator's Phone: 209-836-0965 <br /> 6.TW&YarrRtn&1Qe SYSTEMS INC U.S.EPA ID Number TXR000081205 <br /> 7.Transporter 2 Company Name U.S.EPA ID Num)igr__ <br /> 41�0 1A1, IM4& m�DIV <br /> 8.Designated Facility Name and Site Address - N E , U.S.EPA ID Numbbeeerrr <br /> 6000 88TH STREET <br /> SACRAMENTO CA 9588 <br /> 916-386-4913 CA0000084517 <br /> Facility's Phone: <br /> ga, 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit <br /> HM and Packing Group(if any)) NO. Type Quantity Wt./Vol. 13.Waste Codes <br /> 1. -RCRA HAZARDOUS G 134 i <br /> o (AQUEOUS PARTS WASHER SOLUTION) j <br /> 1 <br /> w <br /> Z 2. <br /> LU I <br /> 3. <br /> 4. <br /> i <br /> 14.Special Handling Instructions and Additional Information L <br /> 01738 CSG`4 <br /> 24 HR EMERGENCY # 844-468-1760(SAFETY-KLEEN) <br /> RUTH AS "AGENT-FOR" by GEN TO RETAIN LICENSED SUIS CARRIERS AS NECESSARY <br /> 15. GENERATOR'S/OFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, <br /> marked and labeled/placarded,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 <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. <br /> I certify,that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a small quantity generator)is true. <br /> Generator's/Offerors Printed/Typed Name Signature Month Day Year <br /> -J 16.International Shipments <br /> 1= ❑Import to U.S. ❑Export from U.S. Port f entry/exit: <br /> Z Transporter signature(for exports only): <br /> leaving U.S.: <br /> W 17.Transporter Acknowledgment of Receipt of Materials <br /> Transporter 1 Print yped Name <br /> 0 r Signature Month Day Year <br /> QTr r.2 Printed/Typed Name Signature Month Day Year <br /> 18. 77repancy <br /> /;7 <br /> 18a.Discrepancy Indication Space <br /> ❑ Quantity ❑Type ❑Residue <br /> ❑Partial Rejection El Full Rejection <br /> 18b.Alternate Facility(or Generator) Manifest Reference Number: U.S.EPA ID Number <br /> J <br /> U <br /> LL Facility's Phone: <br /> w18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> Q <br /> Z <br /> w19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 0 1' H141 2. 3. <br /> 4. <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Ilem 18a <br /> Printed/Typed Name Signature ! Month Day Year <br /> EP� grr �7�1i2�(Qe�. Previous editions are obsolete. DESIGNA ED FACILITY TO DEt9TINrNSTATE(IF REQUIRED) <br />