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Please print or type. (Form designed for use on elite (12 -pitch) typewriter.) Form Approved, OMB No. 2050-0039 t4d 14, Special Handling Instructions and Additional InformationSK T K 1 11611168 0040147879 HAZARDOUS 1. Generator ID Number c'At� f. 2. Page 1 of 3. Emergency Response Phone 4. Manifest Tracking Number SKS 1jUNIFORM WASTE MANIFEST 15. .GENERATdR,SIOFERQP.'S CERTIFIGATIQN:: thereby declare that the cor?tents of this consignment are fully and accurately described above by the proper shipping name, and are classified, packaged, ° `' B-1 marked and fabeladlplag Toted, and are in all respects in proper'cbngition forfrarik- A aaoo�ng to applicable' Intemational and national governmental regulations. If expod'shipment 11,U306n , 5. Generator's Name and Mailing Address Generator's Site Address (if different than mailing address) 1 certify that the waste minimization statement identified in 40 CFR 262.27(a)'(jf I am a large quahtlty generator) or (b) (if I'am a small quantity generator) is true. � STERN FARMS SVC INC CROP PRODUCTION,SERVICES Month Day Year 1 N BROADWAY PO BOX 5188 1755 N BROADWAY 5T h 16.Inlema na iiefifif Import to U.S. ❑ Export from U.S. Port of entry/exit: STOCKTON CA 95295 PO BOX 5188 W 17. Transporter Acknowledgment of Receipt of Materials ---- Generator's Phone: 209-547-2600 1 STOCKTON Transporter 1 Printed/Typed Namenet CA 95205 O 6: Trans iter 1 Compan Name SA TY—KL.0 N SYSTEMS, INC. U.S. EPA ID Number TXROSISM50930 T er yped Sig on ay ear 7. Transporter 2 Company Name U.S. EPA ID.Number_y 18. Discrepancy 8. Designated Facility Name and Site Address F TY—KL.I « SYSTE• INC. ne U.S. EPA ID Number 18a. Discrepancy Indication Space ❑quantityyp ❑ ❑ j ❑ Type t Residue Partial Rejection i ❑ Full Rejection 00 SRTM STREET �' 18b. Alternate Facility (or Generator) U.S. EPA ID Number SACRAMENTO CA 958� J 916-386-4913 Fadiity's Phone:: C ►@@0054517 W 18c. Signature of Altemate Facility (or Generator) Month Day Year Facility's Phone: 4 Z ga 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Containers 11. Total 12. Unit 13. Waste Codes No. Type 3: .T” 4: 711 HM and Packing Group (if any)) Quantity Wt.Nol. 20. Designated Facility Owner or Operator; Certification of receipt of hazardous materials covered by the manifest pt as noted in Item 18a X 'WASTE INT RELATED MATERIAL93o UN12539 Month Day Year DMI P F@03 D001 D016 EPA For 0- 2ev. 3- - vi ""ditions a obsolete. DESIGNATED FACILI 1D601:f07 p 3) 49 0 GE " ERA OR o AC I1, 0 35 DO,39 212 Z 2. W CD 3. t4d 14, Special Handling Instructions and Additional InformationSK T K 1 11611168 0040147879 00093613976 0943 24 15. .GENERATdR,SIOFERQP.'S CERTIFIGATIQN:: thereby declare that the cor?tents of this consignment are fully and accurately described above by the proper shipping name, and are classified, packaged, ° `' marked and fabeladlplag Toted, and are in all respects in proper'cbngition forfrarik- A aaoo�ng to applicable' Intemational and national governmental regulations. If expod'shipment ano,i Pdmary'' ' Exporter, I certify that the; contents of:_Yhis consignment conform to the terms of the attached EPAAeknowledgment of Consent, 1 certify that the waste minimization statement identified in 40 CFR 262.27(a)'(jf I am a large quahtlty generator) or (b) (if I'am a small quantity generator) is true. Ggherators/Offarofs Printedfryped Name ' Signature Month Day Year h 16.Inlema na iiefifif Import to U.S. ❑ Export from U.S. Port of entry/exit: Z Transporter signature (for exports only): Date leaving U.S.: W 17. Transporter Acknowledgment of Receipt of Materials ---- t2 Transporter 1 Printed/Typed Namenet Month Day Year O Qa T er yped Sig on ay ear 18. Discrepancy 18a. Discrepancy Indication Space ❑quantityyp ❑ ❑ j ❑ Type t Residue Partial Rejection i ❑ Full Rejection " Manifest Reference Number: 18b. Alternate Facility (or Generator) U.S. EPA ID Number J U u< Fadiity's Phone:: W 18c. Signature of Altemate Facility (or Generator) Month Day Year 4 Z t O— 19. Hazardous aste RePort, ane9ement Method Cs (I , codes.orh zadowastedtrdius atme 'sal„sad recycling systems) ,e 2., 3: .T” 4: 711 20. Designated Facility Owner or Operator; Certification of receipt of hazardous materials covered by the manifest pt as noted in Item 18a Printed/Typed Name Signature �1 ! Month Day Year Zj ? ; µ EPA For 0- 2ev. 3- - vi ""ditions a obsolete. DESIGNATED FACILI 1D601:f07 p 3) 49 0 GE " ERA OR