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SSL SK SHIP# 22358SGOG IINIIIIIIII IWIII�IIIoil III IIII <br /> 0 0 6 3 6 3 4 6 2 S K 8 <br /> Please print or tyix�IF m des neo for use on ellle(12pddl)typexTiter) Form Approved.OM8 No.211600035 <br /> UNIFORM IIIDOUS t_GerwramrlONumba Z Id 3RWOTEMST =�kD982485352 63462 SKS <br /> 5.Ganeralat3 Name aN MohvVAdaecs C>eneatel's SdeAddras(ddRueM tlan mdngadayaal <br /> Lal–Trans Shop !0' 1.❑di .31-7rans Shop 10• Lodz <br /> 1603 S B St 695 E Pini St <br /> STOCKTON CA 95206 <br /> Gereratars Phone: 209-333--6953 :.CtCri CA 95240-31t,! <br /> a <br /> Mr5YSTEMS INC U.S.EPAIDNumhar <br /> iAR0400?1.'.;; <br /> 7.TaaParler 2 Comparry Naa US.EPA IO Number <br /> MMMA3 222g5!:-2 <br /> TD.-"led FaddyNanm alds� S ETY—KLEEN SYSTEMC. INC, us.EPnlowumea< <br /> 6000 SETH STREET <br /> 916-386-4913 SACRAMENTO CA 95620 <br /> Facrry'67none: LA0000084"I <br /> ger, go.U.S.DOTD-060nPVA4419Proper ShIppag Name.Hazard Gass.ID Nurturer. tO.Cmhalrcas 11.Totel 12.Ihdt <br /> HM ad I`Kft Groups#amyl) No. Typo GuarAly W1JYd. 13.PtesW Cable <br /> I"NOH–KCRA HAZARDOUS WASTE; LIQUID o OF G 134 <br /> 12 (AQUEOUS BRAKE CLEANER) TII <br /> 2 NON–RCRA HAZARDOUS WASTE, LIQUID BF �� G ]?4 <br /> (AQUEOUS fiARTS WASHER SOLUTION) R6, <br /> a. <br /> Ur» —r— <br /> 4. <br /> i <br /> 14.Speaaf Hamtlfing asWdians and itimallM"orbon TSO:SCA .7g94E9Gi" CA076?3 ///12' n <br /> L0�11.�7�4(3�CSG <br /> J23j / <br /> 24 HR EMERGENCY 01-800-466-1760 (SK TFI1 �1 / <br /> AUTH AS 'AGENT–FORT BY GEN TO RETAIN LICENSED SIZE CARRIERS AS ECESSARY 1 <br /> 16. GENERATOR'SIOPFEROR'S CERTIACATION:lherebydecao tlat6amnbnla dlNs am4gevneM are filly ad aauradytlecalbederore bl au Properd@prg masa,and ere dastllWd.Derka <br /> magd and tebel"Placa ded,mo are N all respetla m proper omuct6on forh rmpon aCooM�ng to aPNitame mlemdlrordend neConalgmarnnenUl regula4ana,Ilevpa',Napment and I am sae Prima <br /> Ecarily I OWwasteere Carlon s6naavaipnmam in QCto the 7jaj(the elralarge qu lygmetlgmemldcprAenl. 7 <br /> I mtlfy MOW waste rrenindreaar aWanard identifred le t0 CFR 25221(a)(A I am a Wigs quen'vly generemr a @I Ial am a Rnaa eranRygenaater)®true. <br /> Galec Typed No" Sigw! Alan DDeyy Yaer <br /> J 1 talaaumal Menem GT`/,❑ ��rc <br /> Z Impart to US. L!Ecpon from US. Pat amoy9adb <br /> Traspar4r signature far eapata aHy): Dare leeeag US.: <br /> iT.ttenapoMrAriupWadgmyddRx�yldM]Wfek <br /> T 1 PrimadR Name <br /> Sgcatrae Monro Day Year <br /> 1 pv�e <br /> a a 2 Nana Sgratere Atom a Day Year <br /> } I6.Dbaepwnay <br /> O 1 V? I II <br /> sea msaepauy mdration Strome El <br /> Q,,e"6h Type ❑Revtlue ❑patial Rebctian ❑FWI Rajacaon <br /> ISb.A6anate Fadily(aGaaraar) WOW Reference Number: <br /> J <br /> U.S.EPA ID Nurrura! <br /> e�. <br /> FeaWs Phone: <br /> 1Bc 5gnaWradANarela Feceley(a Geaeralar) <br /> Dey Year <br /> ia.HaseraaleMIStaRWAMaraganem Mdhed Coda he.,CodnWrtamdaa waste treatment disposal,and rtaytlag systema) <br /> I H141 t. H141 3. 4. <br /> I <br /> DoWealed FwAyOesar a Operator:CBN CWM Of No*Of II&WRIMUs Mal"Cared byt amaMfat except as needle Item 189 <br /> .mraolTypaa Name L e <br /> EPA Fpm18TD0-721@evdii Pyipua edUlplte gsq�. <br /> DESIQNAfdD FACILITY TO DESTINIATICIf STATE(IF REQUIRED) <br />