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aS SIC SHIP# 22:3585808 <br /> 00636346 a S K 5 <br /> Please print or type,(Form designed for use on stile(12-pitch)typewriter.) Form Approved.OAfD Nn.2()50-€; 9 <br /> UNIFORM HA2ARp0US t.fienKaler ID Number 2.Page t of 3,Ern$r icy Ruse Pbor)e 4.Manifest Tracking Number <br /> WASTE MANIFEST CA0982*�5531� ;r, z: 006363462 SKS <br /> 5.Generator's Name and AlA;V Adr�esg Cs SAa Address(if dif�rant than mailing address) <br /> Cal—Trans Shop ��' �.L7dx C-31-."r'i�it it a .0a)t4 i.0... Lodi <br /> 1609 S P St 8 <br /> .9r, Con <br /> llxte 5i <br /> STOCKTON CA 95206 <br /> GmcrainrsPittttte: 209--3S3t-6' 53 t ODI CA ?5240-310S <br /> 9. V4—Mr SYEMS INC U.S.EPA ID Number <br /> TXR0110t : <br /> 7,Transporter 2 Comparsy Name <br /> eeunU.S.EPA�Number <br /> t?.13esignaledFacdityl mearrdSde SAFETY-€LEEN SYSTE1. .tai_, U.S.EPAMNumbw <br /> 6000 SETH STREET <br /> SACRAMENTO CA 9588 <br /> 4�1s--88�—�i913 CA0400084517 <br /> F 'a Ptrone: <br /> ga. 96.U.S.DOT Description(erdu ft Prewar Shopkrg Name,Hazard Class.ID Rumber 10.Cornu It.Total 12.Unit <br /> Hlif and Paddrig Grow(if any)) No. Type Quanttty Wt Not. 13,V"W Codas <br /> t, HbN—RCRA HAZARDOUS WASTE: LIOUID O f" 1 4 I(AQUEOUS BRAKE CLEANER) <br /> ) <br /> 2,NE3N—RCy�RA fiAZARL1+ ASH <br /> OiUSuWASTE/ LIQi1.10 <br /> f.17 (AQUEOUS PARTS WASHER SOLUTION) � P76. <br /> i <br /> 3 i <br /> i <br /> i <br /> _..�._ <br /> 4. j <br /> 14.Spacai Handpng kss4ucirons ardAcMiUona!tniorrnaw TSO: SCA <br /> "01743 C51"r E <br /> '24 HR EhERGENCY #1--800-468-1753 (SK t T I) I I��� <br /> AUTH AS "AGENT—FOR" BY BEN TO RET€1IN LICENSFO SUR CARRIERS A fVESAry <br /> 15. GENERAMR'S*MR0R'S CERTIFfCATm: I tm eby dec°are M the contents of this a n*nment are fuly and amuratety described abara by the proper shi;ong awns and are dasstf#ea,packaged <br /> marked and IabelaWacarded,and are in al:rasped$in proper oondl6on for transport aaardkg to appflcaWe Otamafional and reatonat ntal <br /> Exporter I rzrtify that the caaterrts of ttus ma 4� regrdatk�ns.If export atspn> t and I am Yrs Primary <br /> sigamertt nkxm to the 1em>S d the atached cPA AdafC,vledgrnentofi Consent, <br /> I certify that the waste rrrinnimizaiion 641anrant identified in 40 GFR 262.27(a)(!I am a large quantity generator)or(b)(if I ant a$mag 4ual*ganeraw)b true. <br /> Gene r s PrHt rtwad Nam <br /> Month Day Year <br /> +K �23 <br /> _r 16.latemational Shtpmen <br /> va a5 �7 <br /> ❑IMWioU.S. ❑Exportfrumu.s. <br /> TramSpce-signature(fou eKwts only): Die leavrg u.s.; <br /> 17.Trarr,,pater AckrxrMedgmertt of Receipt of Materials <br /> T 1 Prrntadlf Name Signature Month Day Yaar <br /> L7C�� o 13 5117 <br /> S hrtar2 Transpn Name sigralure Month Day Year <br /> 18.Dumpancy <br /> lea Drsrsaganry tndrrat6n Space <br /> ❑ �nWy ❑Type ❑Residue ❑Pat�af Reject cn ❑Fu]Rcy9ct or <br /> Alanifest Reference Number: <br /> 18a.A#famate FaidIty(or Gemalor) U.S.EPA iA Ntxnber <br /> ..r <br /> LL Fadt#ty's Phone: <br /> W 1Ac SegnatureofAlternate FacBEtycorGetlarator) Month Dsv Year <br /> Q <br /> 1B.Hazardous Waste depart K1wmgemartt Me#)od Codes fi.e.codes for hazardous waste€matment.dispose#,and reeWing*tams' <br /> 1 2. s. a. <br /> H#,41 <br /> t <br /> De$�tased Faci4ty oK, or t]peratar Cerbit Ab*n of reC*of haaardars material8 cowered by the mardfesi except as nclod in flora 183 <br /> nntedTyperl Name SignatomMorkrt 08Y Year <br /> opt <br /> 10- 1 <br /> lja*- / 7 <br /> c� t �a� E ° i '' ,�' oEsIr a C3 F, 1ESTi apt STATE()F REQUIRED) <br />