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SK SHIP# <br /> Please print or type.(Form designed for use on.elitb'(12-pitch)typewriter,) Form Approved.0M9 No.2050-0039 <br /> Generator ID Number 2.Page 1 of 3:Emergency Response Phone 4.Manifest Tre m N mbar SKS(� <br /> UNIFORM HAZARDOUS, CADS# 2978E�3 i 1—'f�.. --��r�i'"'; 760 0�����i70 SKS <br /> WASTE MANIFEST-'" <br /> 5.Generators Name and Mailing Address Generators SileAddress(f different than mailing address) <br /> Caltpa,ns 10 (Tracy-, MazTit) CaltraDs 10 iTf'acy- Mail t- <br /> 1603 S .Ea St 2005 Krohn Rd <br /> ST©CKTON CA 9E206 <br /> GeneratoesPhone' 209-835'-6779 TRACY <br /> (._ 137 7" s R ii <br /> B.Transporter 1 Company Name U.S.EPA ID Number x rL <br /> SAFETY-`�{�.,.[Ehl SYS TENS, INC. �!�{'riF����?.�.�51�'1 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number — <br /> 1 �. <br /> 8,Designated Fac:4 Name and Site Address c U.S.EPA ID Nu�ir Wi r <br /> SREETYwK.�.EEh! SYSTEMS, <br /> 6000 88TH STREET <br /> SACRAMENTO CA ��528 <br /> Facility's Phone: . ' <br /> ga, 9b.U.S.DOT Desic ption(including Proper Shipping Name,Hazard Class,10 Number, 1C,Containers 11.Tolai 12.Unit 13.Waste Codes <br /> 7 HM and Packing Group(if any)) Na. Type Quantity Wt.Nol. <br /> 1q--, C,RR HAZARDOUS WASTE, LIQUID ;2 O 6 13.4 <br /> W <br /> z 2; <br /> w <br /> c� <br /> 3. . <br /> - 4 <br /> 14.Special Handling Instructions and Additional Information <br /> -SCA 76711864 CA37086 <br /> 24 HR EnERGENCY 01 r 0p- .: 8-17e�q (8:1 .= TPI) <br /> AUJI4 AS '"AG T- rr rf=i Thi FT Tt+f Tr ,F fFt C - r <br /> 15. GENERATDR'SIOFF59FTS CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the propel shipping name,and are classified,packaged, <br /> marked and Iabeled(placarded,'and are in ell inspects in proper condition for transport a=r6n.9 to applicable international and national governmental regulations,If export•shipment and I am the Primary <br /> Exporter,I certify thal the contents of this consignment conform to the terms of the attached EPAACnowtedgment of Consent <br /> certify that the waste rrtinimizah'nn staiement identified in 40 CFR 262.27(a)(d l am a targe quantity generator}di(b)(if t am a sma2 quantity generator)is true. <br /> Generatd 40fterces Pnnted)Typed,(Vame Signature r <br /> Month Day .Year. <br /> a INalemaffocalShipments,' JIG1� <br /> z ❑import to U.S. ❑Expel From S`. P4rl F anlrylexrt <br /> Transporters gnatureifor experts Only} <br /> r <br /> ' Qaie crying U 5 <br /> w 17 TranspoderAdsnowledgmentafReceEptd#fdateiials . "= <br /> . FXi*TrmansporleriPpntedrTypedName � feOMonth Day Yearo �tei2P1 Ayped Name Si a!re <br /> Month ay Year <br /> i8.Discrepancy <br /> las.Discrepancy Indication Space ❑ Quantity' El Type <br /> ❑Residue ❑Partial Rejection ❑Full Rejection . <br /> -- -•T` i Manifest-Referenbe Ndmber-r_ <br /> i8o-Alternate Fadtriy(or Generator] - _ <br /> U.S.EPA ID Number <br /> Facility's Phone: <br /> LLj 18c.Signature ofAlterna!eFaafity(or ienarator) <br /> Month Qay Year <br /> 19.Haiaidous Waste Report Management Method Codes(i,e.,codes for hazardous waste lreatmenk disposal, <br /> w i. and racydEng systems) <br /> O I 1 ==2. 3. 4. <br /> 20Designated Fad'fity'Owler or Operator.Cert ficatian of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Pnniedl yped Nae Signature <br /> r� I <br /> _ Month aay Year <br /> EPA F=8700-22(Rev.3.05} Previous dibons are o olete, <br /> : )1d941/196�3 `DESIGNATED FACILITY Tp GENERATOR <br />