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7142 002810580$KS Please print or type. (Form designed for use on elite (12 -pitch) typewriter.) Form Approved. OMB No. 2050-0039 UNIFORM HAZARDOUS 1 1. Generator ID Number CAD982343253 2. Pa T I of I urf-mm 4. Manifest Truk WASTE MANIFEST siq n sKs 4. 5. Generators Name and Mailin Address @6jAddr Generators Site Address Of different -than mallm�nr: SEARS A/C 91 5110 PACIFIC AVE STOCKTON CA 95207-631015 209-473-6528 L. SE P 2 3 2611 14. U;;cral Handling Instructions and Additional 16 Von Sg SHIP#2054efth "X 370430 CBS., Generators Phone: "u -6(Z "W9TARLWAnaSYSTEMS, INC. U.S. EPA ID Number TXR0000512114.30 24 HR EMERGENCY #1-80.0-468-1760 (SRFETY-KLEEN - CONTRACT #94138) HEAMJ SK AUTHORIZED TO RETAIN LICENSED SUBSEQUENT CARRIERS- AS NEW§ARY 7. Transporter 2 Company NameVIRONMENTAL U.S.U9EPAUMMI USERVICES 15. GENERATOR'$/OFFEROR'S CERTIFICATION: I hereby declare that ft contents of ails consignment are fully and accurately d=�abo%"* by lhe proper shipping name, and are classilled, packaged,marked 8. Designated Facility Name and Site Address SAFETY-KLEEN SYSTEMS, INC. U�Mlp Number and labeled/placarded, and are In all respects In proper oondillon for transport according to applicable Intemationaland national ammarrial regulations. N export shipment and I am the Primary 6000 88TH STREET Exporter, I certify that the contents of this consignment conform to the terms of the attached EPhAcknowledgment of Corneal: SACRAMENTO 9 CA 95828 I certify that the waste minimization statement Identified In 40 CFR 26227(a) (if I am a large quantity generator) or (b) (III am -a small quantity generator) Is true. 916-386-4913 CA000121084517 Generator'st d Nam Month Day Year Facilli (a Phone: ga. 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Containers 11. Total 12. Unit Transporter signature (for exports only): Date leaving U.S.: M and Packing Group (if any)) Quantity WLNbL 13. Waste Codes No. - I Type 0Z 1 -NON RCRA HAZARDOUS WASTE, LIQUID (BRAKE. DM P 1331 18. Discrepancy 18a. Discrepancy Indication Space❑QuanittyE]Type El Residue El Partial Rejection ❑ Full R*,W, o FLUID) Manifest Reference Number., 18b. Alternate Facility (or Generator) U.S. EPA ID Number =3 cs W Facilit/s Phone: U11 I 19. Hazardous Waste Report Management Method Cxxies (ie., codes for hazardous waste treatment, disposal, and recycling systems) LU 1._ . HI -4 2.1 1 z1 4. 20. Designated Facility Owner or Operator. Certification of receipt of hazardous materials covered by the manifest except as noted In Item 18a PrIntedtlYped Name Signature Month Day Year 12: U.1 4. 14. U;;cral Handling Instructions and Additional 16 Von Sg SHIP#2054efth "X 370430 CBS., "u -6(Z 24 HR EMERGENCY #1-80.0-468-1760 (SRFETY-KLEEN - CONTRACT #94138) SK AUTHORIZED TO RETAIN LICENSED SUBSEQUENT CARRIERS- AS NEW§ARY 15. GENERATOR'$/OFFEROR'S CERTIFICATION: I hereby declare that ft contents of ails consignment are fully and accurately d=�abo%"* by lhe proper shipping name, and are classilled, packaged,marked and labeled/placarded, and are In all respects In proper oondillon for transport according to applicable Intemationaland national ammarrial regulations. N export shipment and I am the Primary Exporter, I certify that the contents of this consignment conform to the terms of the attached EPhAcknowledgment of Corneal: I certify that the waste minimization statement Identified In 40 CFR 26227(a) (if I am a large quantity generator) or (b) (III am -a small quantity generator) Is true. Generator'st d Nam Month Day Year International Shipments ❑ I— import to U.S. D Export from U.S. Pod of entrylexit Transporter signature (for exports only): Date leaving U.S.: 17. TransporlerAdmWedgment of Receipt of Materials WW Transporter 1 PrintedlTyped Name SenaYear o g L 1Mq 1)'(0 Transporter 2'Prinled(Typed Name Signature- Month Day Year 18. Discrepancy 18a. Discrepancy Indication Space❑QuanittyE]Type El Residue El Partial Rejection ❑ Full R*,W, Manifest Reference Number., 18b. Alternate Facility (or Generator) U.S. EPA ID Number =3 cs W Facilit/s Phone: 18c. Signature ofAltemale FaFhty (or Generator) Month. Day Year 19. Hazardous Waste Report Management Method Cxxies (ie., codes for hazardous waste treatment, disposal, and recycling systems) LU 1._ . HI -4 2.1 1 1 3. 4. 20. Designated Facility Owner or Operator. Certification of receipt of hazardous materials covered by the manifest except as noted In Item 18a PrIntedtlYped Name Signature Month Day Year