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SK SHIM°# >r2vl'87�.�88 <br /> Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number CAt)..-000289- 7 2.Pagell of 3. m 6-s*610-11780 4.Manifest Tracking Number <br /> SKSWASTE MANIFEST 0 V K V <br /> 5.Geri rato fs N me aq Mailing.gqddress Generator's Site Address(if different than mailing address) <br /> ij Ill r alier <br /> 12608 S Harlan RC <br /> LATHROP CA 95133"121-8744 <br /> Generator's Phone: <br /> s.T'�� °° �W SYSTEMS, INC. U.S.EPA ID Number r�R �;k 31205 <br /> 7.Transporter 2 Company Nam U.S.f PA ID Number <br /> Man 114zht-d_l� <br /> 8.Designated Facility Name and Site Address V HHVBURS -;H` JUbh U.S.EPA ID Number <br /> SM ,3CISE CA 951,323 <br /> 40B-441--0916 CA 059494310 <br /> Facility's Phone: <br /> 9a. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10,Containers 11.Total 12.Unit <br /> HM and Packing Group(if any)) 13.Waste Codes <br /> No. Type Quantity Wt.Nol. <br /> Dri 1. NUN—HL:HH HRLf4HJJUL1b Wf4bilhLILUID 135 <br /> [AQUEOUS PAINT CLEANING �GLUTION) <br /> a � <br /> W <br /> Z: 2. <br /> LU <br /> C7 <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional Information I _f —0395a <br /> LL, . <br /> 24 HR EMERGENCY #1-800-466-1760 (SKI TEI) I —0c) <br /> AUTH AS "AGENT-ECR" BY GES[ TO RETAIN LICENSED SCAB CARRIERS AS NECESSARY <br /> 15. GENERATOR'S/OFFEROR'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 labeled/placarded,and are in all respects in proper condition for transport according to applicable international 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 that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a small quantityenerator)is true. <br /> Generator's/Offeror's Printed/Typed Name_ Sig re Month Day Year <br /> 16.International Shipments <br /> z ❑Import to U.S. ❑Export from U.S. Port of entry/exit: <br /> Transporter signature(for exports only): Date leaving U.S.: <br /> w 17.Transporter Acknowledgment of Receipt of Materials <br /> ~ orter 1 Printed/Typed Name nature Month Day Year <br /> __ <br /> CL A AP <br /> Q <br /> Tran 2 Printed/Typed Name na <br /> 9 Month Day Year <br /> H L <br /> 18.d1screpancy <br /> 18a.Discrepancy Indication Space <br /> Quantity ❑Type ❑Residue ❑Partial Rejection El Full Rejection <br /> Manifest Reference Number: <br /> F 181b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> V <br /> Q Facility's Phone: <br /> w 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> Q <br /> 0 <br /> z <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 0 1. 11IL211111 2. 3. 4. <br /> Warne <br /> Facility Owner or Operator:Certification of re f hazardous materials covered by the manifest exce Item 18a <br /> S' reh <br /> aA / �� <br /> EPRo(rp 8�� 2 �Previous editions are obsolete. ESIG D FACILITY TO DESTINATION STATE(IF REQUIRED) <br />