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SK SHIF-0 221142131 <br /> Form Approved.0MB No.2050-0039 <br /> Please print or type.(Form designed for use on elite(12-pilich)"writ) �,p 4.Manifest Tracking Number <br /> 1.Gereratnr i0 Number i� 98249782 2.Paga 1 of 3 E ti !.r�v�) V Svc <br /> V <br /> f UNIFORM HAZARDflU5 i- V <br /> WASTE MANIFEST <br /> Generator's Site Address(if o rent rn nraifing address) <br /> 5.Generators Name and f�ailrg Address r - ] f .1� {. r f c'Y C — 1;�3 R t f <br /> Caltrapt� 1� •.Tr3c ;ray t 00 Krohn Ed (p <br /> 1603 5 9 St CA ?S206 <br /> STEIf'1(TQN TRACYCA �'E37�-`���{ <br /> 09-535-6779 <br /> Generators Phone: U.S.EPA ID Number 7 rmoos 120E <br /> SYSTEM'?5, INC' <br /> U.S.EPA ID Number , <br /> 7.Transporter 2 Company Mama ' �� ) jj <br /> B Designated facil y Nan a and Site Address j. ET�'" 2EE�BYS7^-F'3% t U.S.EPAID Number <br /> 6000 88TH STREET <br /> SACRAME N Gf� 9�G nn4S,�-- <br /> 916'-386-4913 <br /> FadlVs Phone: <br /> 9b.U.S.COT Description(ir�uding Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11,Tata) 12.Unit 13.Waste Codes <br /> 9a. Type <br /> Quantity WtNol. <br /> HM and Packing Group(if any)) No. <br /> 1. Fi N IRCRA KAZARDOUS WASTE, �It3l3I�r f:': <br /> Of iAQUEGUS PARTS WASHER SGLUTIGH) $ � 0 <br /> l <br /> Z 2. <br /> W <br /> 0 <br /> 3- <br /> 4. <br /> r .7,y 75 %71�S TZ' CSE,' 2 4 <br /> 14.SpeaaiHandlinglns.ructiansand AdditllstialEnforcnation ;5J: 31�'r-1 7w��70 43 CR;3� 19;� r+- <br /> 24 HR EMERGENCY "1--800-462-1760 (SK 1 TF'I) <br /> Ai3T:a i15 ,AlsEi�T- C ,rr `f GEtf TC; RETAIN LICENSED S-UF CAR IEP Al-, SEC=:Sa' F;Y <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, <br /> marked and la'aeledlplacerded,and are m all respects in proper conrfctien for transport according to applicable intemational and national governmental regulations.If export shipment and I am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. <br /> I certify Ihat the waste minimization statement idenfified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b),RI an a small quantity generator)is true. <br /> Gaiaratorst0 s pArteoffedNarne t` 5 re ) Month Day {Year <br /> 16.IntemahonalSt,j)nlrmtsr <br /> f ❑Import to U.S. ❑Exportfrom U.S' Port ofeneyfex t <br /> :Transporter., nature(t6reXports omly): Date leaving U.S.: <br /> w 17.Transporter Acknowtedgrnenl of Receipl of Mateaafs, - • . - <br /> Transporter 1 PrinteVyped Name Signature Monlh Day Year <br /> M T anspoder 2 Print d Name Signature Month .Day Year <br /> la-Qncrepamy <br /> 1Ba.Discrepancy Indication Space Ouant ty ❑Type ❑Residue ❑Partial Reiechcn ❑Full Rejection <br /> Manifest Reference Number, <br /> 186.Agemate Fadfify(a Gene®tcr} n U.S.EPA ID Number <br /> U <br /> ia+ F.61ity's Phar: <br /> LU 1 Bc.Signature of Altemate Faality(or Generator) <br /> r.., Month Day Year <br /> a <br /> z <br /> y13.Hazardous Waste Report Management Method Codes(re.,cedes for hazardous waste treatment,disposal,and recycling systems) <br /> LLI Q 1' ill 1i 2. 3 a. <br /> 20.Designated Facility Owner or Operator:Cetfica5on of receipt of hazardous materials covered by the manifest except as nded in Itern 19a <br /> Pnn Name <br /> I <br /> -y ./y ��YJ Month Da Year <br /> EP L 1CJ <br /> f ] <br /> �+�F,. ?� 3 Previus editions are ohs a. DESIGNATED FACILITY TO GENERATOR <br />