Laserfiche WebLink
RECEIVED BY SJCEHD (EF) ON 2/5/19 <br /> r ,_gL Sk SHIP# 21L&499: 1-1 <br /> Plesse 00tor type.(Folin designed far use cn elite(12-pitch)typawriter.) Form.APPMved.OMB No.20WM39 <br /> UNIFORM HAZARDOUS 1 Ganerater ID Number 2.peg tot '3 E r e cY e e 4.tyterttfast Trackfin Numher <br /> . WASTE MANIFEST. �`3.+�k 0� . $n� : <br /> 5,Osnerator's Name and Malft AddmsLa Generator's SlteAddress([f digarant than mailing address} <br /> spat-�Tvans SE�+:rp :10– Lodi (:aAddm w Srentth t. ; oressLodz <br /> tit 045 S R`-bA.< S-� <br /> stocktar Ch 95,206 <br /> Generator's Phone:mm9 <br /> SiN Y�K!p�aa~ a1�e;s'lrS•1ENSr llgc" U.s.EPAtDKumbar <br /> s•1tFja�.�t�,<<�Y 4� <br /> 7.Transporier2 Company Kama U.S.EPA Ip Number <br /> e.Ceslgnated Facility Name and Site Address +SflE�1": SYST <br /> Epls_ ;:e"lu- U.S.EPR iD Number <br /> 6000 88TH STREET <br /> 916–',486-4913 CA 95MM <br /> Fectiii4Phone: <br /> 9a. 9h.U.S.DOT DawAption{including Proper Stripping Name,Hazard Class,ID Number, 10.Containers 1T.Total Q.Ung <br /> HM and Packing.Groun(if any)) No. Type 11.Total <br /> 4 .uriI, 13,Waste Codes <br /> I-NON—RCRA HAZARDOUS 14YAST , LIQUID OF � J.34 <br /> (AQUEOUS BRAKE CLEANER) ' <br /> z 2. h1 € -TCRA RA7ARDIJ S WASTE, LIOUxO(AGUEOUS PARTS WASHER SOLUTION) t? E � <br /> 15 <br /> 3. <br /> 4• <br /> 14.Special Hand&ng lastructions andAdditionai lnfoma$ea TED::;iVA 67467323 CA37093 7171 SE2 2 [:y^.0;2=1 <br /> 6 <br /> 24 HR LNCE�UtCK f it 1-800-468-,.' C'S FE . .. ,, ,r� ; <br /> K �311f�f13F�.Tli; ` O �44�:Y�lI L I4 NSE-r:3 S1.fMSEOUQ CARRIERS t� t��:f t:;.:7�ih`� ��`I <br /> tT E;r� <br /> 45. OEHERATOR'SfOPFFJtOR S CERTIFICATION:I hereby declare Ihat the contents of this oohalgnantare fufly and accurately dew ib�d above by the par shipping nem@,end are classified,package <br /> maftd and lahetadlplacarded,and again allrespec(s in proper cgdliion(or tranapoa Molding id applfca6le Hemallorial and nationalr?0 governmental r ulatlms.If pac ag <br /> Exporter,I certify thAt IhA'oenlents of tats consignment conform to the terms of the at!adwd EPAAcknarModgment of Consent g °H s ripmentand I em he P unary <br /> I certify[hat the waste minimization slalamanl iden4fied In 40 CFR 262.27(x)(If I am a large quantity genera#x)or(b}(Ifl sm a smati quantity generator/1-true. <br /> Gensrerors! esPrintedlTy Warne Slgnafli / Month Day Your <br /> . .1 18.Inteme5dhe Shipments <br /> ImparFto U.S. ❑Exporf from U.3. : Port of entrylaxit <br /> Transporter s gnalure(far exports onl): DateJeai ng U.S.,: <br /> t7:TralspoiterAduiewferig(n]nrb Receipt of tAetat els <br /> ransporferntedlTypa¢Name_. <br /> - `. 5gnatura Montl( Day : Year <br /> Tran3POW 2 PrvltedlTypad Noma ' <br /> 51gBatu a Month 4ay Year <br /> 18:Discrepancy <br /> 1 as.Discrepancy Indication Space ❑ aardity ❑Type ❑Residue ❑Partial rZe)eciton ❑Fall kedion <br /> Manlfast Reference.Numbev ' <br /> TOb,Attemate Facility(°r Gene(aEor} U.S.EPA ID Number <br /> U <br /> L 180.Sgnabn ofAltemate Faddy(or Generator) y <br /> 4 hfortdr pay Year <br /> Z <br /> 18.Hazardous YNasta Report Msnagemeni Method Codes(i.e.,codes for hazardous waste trealmant,disposal,and recyciing sysems) <br /> 1. 11141 <br /> 20.DaslgnaleMp6lily Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item i Be <br /> PrinlediT jdama Signature Month Day Year <br /> PleAyul ,Q 6pns DESIGNATED FACILITYTO C, NE€iATdFI <br />