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SSL SK Stiff* 4200 POZI97 ilihlilllllllilllllullllllllllllll <br /> Please print or .IF=designad for.,.an else 1,12-pitch)typownw.) 0 0 5 6 3 1 7 7 0 S K S <br /> tj UNI FORM HAZARDOUS 1Garelaw Nwr�ba r'VU 45R—Sl;ti Form Approved,OMR No.2050-0039 <br /> WASTE MANIFEST CAD98248535i 2.P tot 37E �. tTheldllp Nanhar <br /> �.OenamlNa Name eM MaUng Address oergreta(a Sllemdre9smtlNNPoN aan Q5631770 SKS <br /> Cal-Trans Shop 10- Lodi maRg777,.' <br /> dd ess) <br /> 1603 S B St Cal-Trans Shop 10- Lml5 <br /> STOCKrON CA 95206 S45 E fine St <br /> Genaala's Phone. 209-333-6953 tool <br /> ::A 45240- is <br /> 6.Tt.CoRpnaNama SYSTEMS, INC. u.s.EPA lD mamSa <br /> 7.Tmslssder 2TCamI(paz�rytxYutnVe TXR00006 i20 r, <br /> U.S.EPA ID Number <br /> 6'oea4nam avRxemamdSRAamvaa SAFETY-KLEEN SYSTEMS• INC <br /> 6000 88TH STREET U.S.EPAIDNumber <br /> 916-386-4913 SACRAMENTO CA 95828 <br /> Faoylys Poona. I�A0000084�;17 <br /> 9'. 9b.U,S DOTOesaipdal( gPmperSNppyig Naa0.Harerd(2aes,ID Number, 10.Comei <br /> HM and Pm^awivaM11 nars 11.Total 12.UAK 13.Wa9h Codas <br /> t NON-RCRA HAZARDOUS WASTE, LIQUID NO. Toe r Wwa. <br /> (AQUEOUS BRAKE CLEANER) I OF G 134 <br /> 2 NDN-RCRA HAZARDDUS UASTE, LIQUID <br /> (ADUEOUS PARTS UASNER SOLUTION) DM 20 G134 <br /> 3 <br /> a. <br /> 14.9PW Hard ingNsWcaonsandAdditionalInformation TSD:SCA 72110864 CA37L 1201651 '88:2 <br /> X58:23 <br /> AUTHRASMEAGENTYFOR"8HY GEM TO RETAINJLICENSED SUR CARRIERS AS MAP <br /> `� <br /> 16. OENERATWWVFFERDR'S CERTIRCAnoN:I harebY tladareNml aw unateals d Ndeconi <br /> marked and Mbeladlplecarded,and we in aim in rsrepercondi6m Wraarepan di�gnmMtalamayand axwalNy daecrPoed a8ore bytlle pmaa aNppay soros,and are tlaseirea,paUagad. <br /> Exporter,I Monty mal the Wroands of tlds epp1�hNrretior®IaM sgaonst 9o+emmeMalregule8gp.If 91pall sNpmemand I am tlse Pnmary <br /> I Wrtfy mal the waste mnniratiunaaNanlem kmofpp�w R262�)(.f l em a 6vwa (b �m <br /> GBnereto7si08erot,Pr Rypad NNre "�'g°nora�a@1(dlemasmall draw, rator)is he. <br /> Signature 1 y�/ Year <br /> J 6.InEeea Pi lomeMa (y 7 <br /> sgreoua0are Nnportm U.S. Li Export from U.S. Ponof a^ay <br /> Tma9 iter app ady1; <br /> Dalelea' U.S,; —. ...—..— <br /> TmnepakrAtlmoawdgmen,WRe4psofaglenals m9 <br /> T i Freda ap<dp) <br /> ((FSS D M o� ) Year <br /> 'r Name Si9naLLre Mab Day year <br /> 18.Discrepancy <br /> 188.Discrepancy lnclutu,Spoor Ouantily ❑Type <br /> ❑Resdw ❑Partaf.Rejection LIFUN Rejection <br /> i6E ANurnete FerBNy la Oenemwrl Manifest Referem Number. <br /> ..i 0.S.EPA 10 Number <br /> Faoldys Phan' - <br /> 1W.3WaWfaofAlternate Fady,_rienemla) <br /> dMonth Day Year <br /> 19.yfazallous Wage ReportMmagemamMempd Codes pa.,mtlesforlffiareouswas,a,reabnen4 d!spoeel.end racysWg sYetamsl <br /> c 1' H141 2 H141 3. a. <br /> l 2a Da®g okO Faayry Oxw ar Opemb DaMmea dm aNa hazmWus ma erayaaeatl by tip mangeNexaeWas MedN Nan lea <br /> a Hanle SgraNre <br /> on Del. <br /> tpyipuad�dm <br /> EPp FtM��), 2f� P DESIGNATED FACILITY TO EMSTIOnCIN STATE(IF REQUIRED <br />