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SaL Sk SHIP# 224312537 iiiiiiiiiiiiiiiiiiiiiilimilillilI <br /> Pieese pdni or type.(Form designed for use on et"sfe(12•pitch)tyfiewrttecj OG 65316543 K3Farm Approved.t�tu€13 Na.2d�f}-t}[139 <br /> UNIFORM HAZARDOUS t.Generator ID Number c 2 Alif 01 E 4.Manifest Tmekirt Number <br /> WASTE MANIFEST 11e24 � ' -r 9 F $ " , 6 J 31 5 KS <br /> Generators Name and Mail ng Address Generata's Si&Address(6 different than.,nailing address) <br /> Cal-Trans Shop 1C-- Lodi Coal-Trans Sh4ap 1.0_. LULJJ. <br /> 1603 S b St B45 E PiRe 5t <br /> STOCKTON CA ?5206 <br /> Genarator°sphone 209-333-6953 l ODI CA 95240-3106 <br /> s.hfIf , RMWSY STEMS YNC. U.S EPA 10 Number TXR00O08120S <br /> T.Taansporter 2 Company Name USS EPA <br /> �l0 Humber <br /> 8.01i Fai Name and Sle Address SgEETY €{LEEN SYSTEMS: NC. U.S.EPA I[:Number <br /> � �2 <br /> 6000 88Th STREET <br /> SACRAMENTO GA 95828 <br /> 9�b-3Ct6- 913 E:A4i1bb08��r <br /> Fariiit s Phone: <br /> ga. 3b.U.S.DOTDescriphnn(including Proper Shipping Name.Hazard Gass,in Number. ?©.Cor talrtars 11 Tolal 12.Unit <br /> HFA and PaC}cing Group 1 any)) i3.Waste Codes <br /> No. Type Quantify wt Aw <br /> t. <br /> � E � s <br /> s <br /> 2 NBN—#MCRA HAZARDOUS UASTE, LIQUID F�F— G 134 <br /> >; (AGilEUUS PARTS WASHER SCUJTIGNil <br /> 3. <br /> i <br /> 4. <br /> 14.Spedial Hand i InsintcUons and Add'stional Iribm tion ? , 2 w. <br /> "� TSC}:SCA f5ts$b5x53. GA37G9,. �.�1,83 t�SCi: r..i <br /> 24 Hid EMERGENCY #1-e00--468-4760 (SK r TFI) <br /> AUTH AS "AGENT—FOR" BY GEN TO RETAIN LICENSED SUB GARRIEPe AS NECESSARY <br /> la GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fu'€y and accurateeily described above by the proper shipping name,ardare elassifiod,packages. <br /> marked and labeliedfplacarded.and are in ali resper_ts in proper oandi,iort for rxrtsport according to afiplicab'e intematattaf aro nationat govermttenial regulations.If export shirpment and I am the PrWrary <br /> Exporter,I cert'fy nat rhe coriuutts of this tbnsi w*nt owform to the hennas of the attached EPAAdcrxxvledqumrt of Consent <br /> I certify that the waste mirkm tion nt idenVied'k't 40 CFR 262.271a)lot I am a large quantify genera=.w)or i jiff am a small ar,* a tori is hue. <br /> Gar ratorsr edrTyp ame $gna ire h4onSr pa Year <br /> J 16.Intemationa'•Shiprnents E <br /> I� � <br /> f I_ i to U.S. ]Export from U.S. Pori cf anlrjli it: i <br /> Traaspurter signaWre Ilan expoers only}-. Date IaiiVing <br /> w ':;.TrarslxrterAoknewia#green a€ReceiptoiMatera(S <br /> oIra Cr 1 PrintedrT Name S:gnaturg mon'., Day Y a� <br /> fl. T 1 1GXJ <br /> Q Trarspi P' dhiame signature wruh Cay 'year <br /> fx <br /> f— <br /> t 3.Disorepancl( <br /> 18a.D*crepansg indicaiicn Space ) <br /> Quantity _Tp32 ❑Ras,due Partial Rtpizwn ❑Full Reje vor <br /> Manifes'.Reference Namhar: <br /> tBT.Ar�smate Facil4y ier Ganera!ar1 E1.5 EPA i(}Number <br /> J <br /> eQ+- Fac-0y'6Phone: <br /> tai SvnaWreotAltemateFadiiy(orGaneraton <br /> tionth Day Year <br /> tic <br /> v51$.tWardo.rs Waste Report Menagemant Methal Codes ti a.,codes for hazardous waste treatment,dispota€,end recycling systems) <br /> f. 4+"t z. H141 4. <br /> r — I Z <br /> 20.Dai Wd Faaity(%Tier or Operator.Cadfrcat,on of wefpt of hazardous materials onYered by the manifest except as noted i Item 1Sa <br /> PrirrTyped Name Signature ti dr Day Y <br /> v�t nig e� I e DESIGNATED FACILITY TO DEST3 10 STATE(IF REQUIRED) <br />