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/ SSL SK SHIP# 221625321 <br /> Please print or type.(Forrn designed for USO on elite(12-pitch)typewriter.) 0 0 5 7 4 2 6 5 9 S K S <br /> t.Gerierabr ID Numt¢r 2.P 1 oFtp AFP +red.OMB No.2950 0039 <br /> FfINIFORM�KAZARMUS�� No <br /> TIw MANtFF.5T CA09824 �1 �1� 0 QKanUeSt Q 5?4 2 6 5 <br /> Generates§Name and pry Ad s 5 K S <br /> Gat—Trans Shop 10— Lodi t�rssRaare (it d tirmargars . <br /> 1603 S B St 'e —Tram Shop ip— Lctc�� <br /> STOCKTON CA 45206 845 E Pine St <br /> GeneratoesPwne; 209-'333-6953 <br /> S.Tm LODI <br /> CA 95240- 08 <br /> .� SYSTEMS, INc, U.S.EPA ID Number <br /> TXR0000812oS <br /> i Transporter 2 Company Name <br /> U.5_EPA tM f l i 21,M__�5�.J <br /> s.[3esignatedFadlRyNameandsiteAadress SAFETY—KLFFO1 SYSFE1t8: IhtLI_ <br /> 6()00 BST# STREET' tJ.S.Ff'AIBNumber <br /> 916-386-4913 SACRAMENTO CA 95828 <br /> Fa±is phorc C A00000845 3 7 <br /> 9a, &t.U.S.DOT Descrgrtiorr(Wu*l g Proper Shipping Name,Hazard Class.ID Number, <br /> HM aitd PKbV Croup(if"a ) i(f.Containers 11.Total 12.LIM <br /> f, RA HADA DGli,t iJABE, No. Type Quantdy WLAbL 13,Waste Codes <br /> LIQ€,1Ib <br /> (AQUEOUS BRAKE CLEANER) � DF G 1�44 <br /> (AG E`OUS PARTS WASHER SHUTION) DM <br /> o -, - <br /> 3. <br /> 4. <br /> rlee 14.Special ffandiing tnetructiatsgandAdditatlnfotrra;ipn <br /> rr' <br /> r _ <br /> 24 HR EMERGENCY #1-800-468-1760 (8K J TFI) ZESISAL <br /> AUTH AS "AGENT—FOR" BY GEN TO RETAIN LICENSED SUB CARRIEFs8 AS RY <br /> 15. GENERATUR'SIOFFERt7R 3 GERTIFtGA5V_: i hereby d..bm drat the=tats oft*=134vrredt aye and <br /> marked and IabeledfN�rded,and are n a4 respects proper corkHtian for !desgitted above by ilia Pmp�sfi Aping and aru dassiiied,packaged, <br /> Exporter.I certify that the ox4ents of this can' mrent transi applicable intemationatand nations govemman(al regufabans,d export shipment and I am the Prkriary <br /> I sei <br /> certify that the waste mUrimization slat'neht WWbfied in t R 262.27(a)(tf#of dam "nbtY abdied nowledgme r of C(?lama <br /> ?l am <br /> Generator sl0derofs NritedlT quantity gerreratorj or(bj(if I am a smaN qu 'ty generator}�5 true. <br /> Signature <br /> r <br /> v �1.Ga✓t <br /> � <br /> is.International 5hipments <br /> ❑Irrgwrt to U.S. ❑Exrrort from U.S. Port of lexb <br /> Transporter signature(forexpi 0*1: —..-- — -_ - <br /> 17.TrartgpafierAdm wtedg€nmt ofgate <br /> Racarpt of Materials <br /> Trd 1 yped Name 5ignettxe <br /> It <br /> month Day Year <br /> a Trans TvinedName <br /> Signature Menth Baayy Year <br /> ta.clisrsapaacy / 112 <br /> 18a.DLSCroparxy indication Space21� <br /> ❑ Chtanlhy ❑TYPE ftesioue <br /> Partial Ralea5. ❑Full Rejection <br /> tab.A€temate Facikty(or Generator) hfanifest Reference Number <br /> -.+ U.S.Iwi'A ID Number <br /> u <br /> si Facgays Phare: <br /> w 18c.Signature of AitemWe Facility(or Generator) <br /> Aloritfi pay Year <br /> 1 S.Huzardons Waste Repwt INanagement f.1&thod Codes Ve.,codes 1a hazardous waste treatment.disposal,and recyding systems <br /> Q t" H141 2. H141 3, 4. <br /> Designated FaW4 Owner or Operator:CertfnaWn of fei of hazarfts maleriais carered by the manifest except as nclad in Item 18a <br /> erne Non1h Day Ytaer <br /> i �� 8� l AT FACILITY TO o tori STATE(tt=r� ctt�ap <br />