Laserfiche WebLink
II tt I I <br /> SSL K SI-IIF`# 223sess?8 <br /> 006363462SK5 <br /> Please print or type.(Farm des ea for use on elite(12•pitcil)typewriter.) Form Approved.OM3 No.2050-0039 <br /> # WASTE MANIFEST UNIF4RM HAZARDOUS 1.GelsaraSor ID t rrrber 2.Pa"t of 3„. Noir C Mariftl Tracking Ntun6er <br /> 1 Gt"E79$cry$��3_ <br /> W �� - 1006363462 S KS <br /> S.Generators Name and Ma2Gdsng Address GAddress(d dgerent than rnat8ng adrtressl <br /> ('al Tr ani :5=10r, 1.0— Lodi Cal. j'e�r1t_ Shop 10-- Lodi <br /> 1603 3 R S1. 849a E PiTte at <br /> STOCKTON CA 5)5206 <br /> Gerwsarot's Pham: <br /> g -333 b1S3 >._Ci�-; FS �J•.. ?� <br /> 8, 99ftkff'-Tft�1rSY4TEUS isc U.S.EPA ID Number (XFCt)Q4)()2i?o.7 <br /> 7.Transpotler 2 Company Name U.S.EPA ID Number <br /> 8.DesignatedFatA4Nam and sib Adm SAFETY—KLEEN SYSTEM, 114L. U.S.EPA ID Number <br /> 6000 88TH STREET <br /> SACRAMENTO L", 9S812L4 <br /> 16-386-4 T 13 C.A0000084 17 <br /> FadWs Phata' <br /> 9e. 90.U.S.DOT Desorlption((ndW"Proper Shipping Name.Hazard Class.iD Number, 10,Contair€ers V.Total 112.U118 13.Wasta Codas <br /> Hy acrd P8ddn9 C-0uP(if any)) No. TiF. Quantity+ WWI. <br /> 1. NON—RCRA HAZARDOUS WASTE: LIQUID � � C 13:4 i <br /> a� (AQUEOUS BRAKE CLEANER) <br /> r� 1 <br /> Z 2•N©N—RCRA HAZARDOUS WASTE, LIQUID � � G 174 i <br /> a (AQUEOUS PARTS WASHER SOLUTION) <br /> L7� <br /> 3. i <br /> 4. <br /> `4.Spec:6ttandkftglnsbucbnsandA krfamation TSD: SCA 74 '•369642` CA37093 201743 C55:23 <br /> V7 1 <br /> 24 HR FrIERSENCY #1 �80C-468-1760 (SK 1FI) � Ld © � <br /> AUTH AS A€ENT—FUR BY GEN TO RETAIN LICENSED SUP CARRIERS AS NECESSARY <br /> 15, GENERAT0R'SKffER0R'S CfRTiP1CATVM; I trereby declare that lPewntents of acts masignment are fuly and accnratelydesaibed above by the proper Supping nntrre.and are dassitied.pa&a*. <br /> marked and labeledoacarded,and are In all respects in Proper condition far t wswrt acoon rtg fa applicabie irkas bonatand naktrtal g svemmental regtrfetions.If export 5t pment and I am tie Primacy <br /> Exporter.3 wtify that the contents of this consignment conimm to the terms of the atsadmd FPA ACImaMedgmenl OF Consent. <br /> I certify That the waste minimization statement idandf ed m 40 CFR 26227(a)(if€am a large gvargity generator o<(b)(d 1 am 9 Stt1 q rantity generator)is Inca <br /> Genera S F7in rryped Nam S Month Day Year <br /> 15 I? <br /> _t 16.InlarnatienaiSipmen <br /> �— ❑import to U.S. E Expmt from U.5. Port antryiexh:...... <br /> _.... <br /> Tra=ijwlor akjnahua(tar aappds on€y): Dale leaveg U.S:. <br /> t43Ci3 17.TramspdterAdtnowledomw t of Recao of MawrWs <br /> Tr PrimerlfT Name Signature M€x�iti}€ Day Year <br /> Trans r2 a NameSignature Afonlh Day Year <br /> 18.D� ncy <br /> 18a Discrepancy tnd cation Space <br /> 1—, Quantity ❑Type ❑Residue ❑Pa>5al Re*ti- ❑Fral Rr3jectiat <br /> WnOest Refertmce Nu'ntter: <br /> 18b.AIMma6a Fadkty(or C-ftw kx) U.S.EPA ID Numtw <br /> V <br /> FaciaTf s Phorse� <br /> f&:SgnatareofAlteMteFaakryforGiettamtot) wwh Day Year <br /> Q <br /> Z <br /> 55 19,KazaMous Waste Report Management Method Codes(i.e.,Lades for ha2wdaus waste treatment disposal,and recycling systems) <br /> © 1 H1.41 z' H141 3. 4. <br /> t <br /> Des'grrated Facifiy Owner«C>perarar:Carti6cation of receipt of hazardous rrr€rtarials rA+nered by tt€e manliest except as rwted Bt ttam 18a <br /> .nn?adr ypad Name2itare �,. � Month Day <br /> fPkFi46 f7( t5D1 P J #( l.r fj''j�eJ/�f `(J// QESIGNA D FACILITY To DESTE ATI10 STATE(IF RarE`QUIRED) <br />