Laserfiche WebLink
SSL SK SHIP # 221625321 1111111111111111111111111111111 <br /> � 0574265 & SK5 <br /> Please print or type.(Form designed for c!se on elite(12-pitch)typewriter.) f=orm Approved.OMB No.20%4 0039 <br /> t I UNIFORM Nu <br /> HAZARI)t]US 1 Generator ID Numtwr 2. 1lanlfestTracking mber <br /> ° 4�s�� 3 � � `�� 14.005742658 SKS <br /> 1e� <br /> WA MANIFEST <br /> Generalw's Name and Ii!ing Address Gener Irr s Site Add ass(if dittetent rnan address <br /> CaZ -Trans Shop 10- Lobi ori-Trans Shop IT'-add <br /> 1603 8 B St 84S E Bine St <br /> STOCKTON CA YE206 <br /> Generators Phone: 209-333-6953 LORI CA 95240--3108 <br /> T�destCo��e SYSTEMS, INC. U.S.EPAIDNumber TXR000081205 <br /> I'ransporter 2 Ccenpany tVama � U.S.EPA. <br /> 6.DesignatedFaciityNam and Site Address SAFETY-KLEEN SYSTEMS_ INC, U.S.EPA iDNumber <br /> 6000 88TH STREET <br /> SACRAMENTO CA 95528 <br /> 916--386-4913 CA0000084S 17 <br /> FarAdyls Plane <br /> ga. 9b.U.S.DOT Descxipton(wquding Proper Sipping Name,Hazard Class,ID Number, f(I.Containers 1?.Total 12.Unit <br /> HM and Facl*Group(if any)I 13.Waste Codes <br /> No. Type Quantity Wt1Vol. <br /> i- MON-RCRA HAZARDOUS WASTE, LIQLFITJ 0 I �4 <br /> aa (AQUEOUS BRAKE CLEANER <br /> e� <br /> WASTE, LIQUID <br /> 2 (A€UEOUS FARTS WASHER SOLUTION) � OST � G 134 10�. <br /> 3. <br /> 14. <br /> 'Inc 14.Special Handling Insh w6ons end Additional Womlatian 2 <br /> 01 10 <br /> 24 HR EMERGENCY #1--800-468-1760 (514 / TEZ) <br /> 0 7-f*-rf� <br /> AUTH AS uAGENT--FOR" BY GEN TO RETAIN LICENSED SIB CARRIERS AS NECESSARY <br /> 15. GENERATDR'SIDFFEROR'S CERTIFICATION: E hereby declare that the oxd8ms of this mnsignmient are fatty and accurately described above by the proper shipping name,and are Bassi seed,packaged <br /> marked and labeled p ap tied,and are in ail respects in proper corKbdcn for transport according to app6cabis in emational and national 9ovemm mal regulations,h export shipment and I am the Primary <br /> Erporter,I certify that the extents of this consgnirrmt c inform to the terms of the attached EPAAcknowledgment of Consent. <br /> I certify that ttra wash mWmizai statement ideritfied in 40 CFR 26227(s)(if I am a large quanbty generator)or(bi(if I am a smail quap generator)is hue. <br /> GeneralarslO69rofs PdntadlTyped Signalura A+ Y <br /> t <br /> b "v r+l 4a i1 X t <br /> -J 16.Intem25anai Shipments <br /> ❑Import to U-S. ❑Export from U.5. Pon of fexq; <br /> — Transporter signaiiue{!or expor`s aMyj; Date U.S.: <br /> 17.7rartsWar Admowiedgment of Receipt of Materials <br /> UJI <br /> Traer 1 Printrq(:� <br /> ped Name SignaluN <br /> M" Day Year <br /> CL u p / <br /> Q TranM. j <br /> ed Name Signature Month eDay Year <br /> & �� ! <br /> 18.Disaepancy <br /> 18a.D screpancy Indication Space ❑ Q,.tv ❑Type tl Residue ❑Partial Rajoelion ❑Futi Rejection <br /> Manifest Reference Number. <br /> 184,Mtemale Facility for Generator) U.S.EPA ID Number <br /> C,a <br /> FaalWs Phone, <br /> EU i tk.Signature of Alternate Facility(or Getteralor) AW-1h Day Year <br /> C <br /> Z <br /> re18.HazarftUs Waste Resor€Management 1&uiad Codes(€.e.,codes for hazardous waste treatment disposal,and recys;ing systems) <br /> Q 1, X1141 2. Hl43 a. a. <br /> Oesignaled Facility Owner or Operator Cerlikaiton of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> am � � MonthLL Z� �:5 1 Day 1Y. <br /> EPPfyrWtt�tpl.(�& j Pff"4"jftg" SI AT D FACILITY TO D I0N STATE(IF REQUIRED) <br />