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Form Approved.OMB No.2050039 <br /> Please print or type,(Form designed for use on elite(12-pitch)typewriter.) 2 Pag 1 of 3 m se hoe �Manifes Tracking Number05947218 ��1eratorIQNumbsrHAZARDOUS �-S ANIFEST,.ne and Mailing AddressGenerator's SlteAtldress rf different than mairess). <br /> t1t� ADS > ' 1 <br /> ' � ? r� ' , tie 1 e 4 ' Sa t <br /> TRACY;' CA 7 TRACYCA 95377-9708 <br /> ` -3934 <br /> Generator's:Ptlone:��pp y y geeU.S.EPA ID Number <br /> SYSi E , INC <br /> U.S.EPA ID Number <br /> 7.Transporter 2 Company Name <br /> x U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address �TY�({I CALIFORNIA <br /> 6880 tRt19` CA 9456? <br /> 510-79-5-4400 A <br /> Facility's Phone: ' <br /> 10.Containers 11.Total 12.Unit 13.Waste Codes' <br /> 9a 9b.U.S;DOT Description(including Proper Shipping Name,Hazard Class,ID Number, No. Type Quantity Wt.Nol. <br /> HM and Packing Group(if any)) B <br /> TT <br /> A HAZARDOUS WASTE� LIQUID <br /> p ( �L) � <br /> W � <br /> z 2. <br /> W <br /> 3. <br /> 4. <br /> A <br /> 4.Special Handling Instructions and Additional Information TSS <br /> i 1.9 C 2 <br /> T <br /> y , <br /> IERS AS <br /> ra 5 lT�e ra BY BEN AT ON: declare that the stents of this cons g mantas fully and a ria el deescnbedd abovNECESSARY <br /> by me proper shipping name and ate"da sified packaged; <br /> 15. G)NERATOR'SIOFFEROR'S CERTIFIC Y <br /> marked and labeled/placarded,and are in ail respects in proper condition for transport according to applicable international and national'govemmental 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 EPA Acknowledgment of C nt. <br /> I certify that the waste minimization statement identified In 40 CFR 26227(a)(if I am a large quantity generator)or(b) am a sural uantily n rator)s true. EMo;th ,� Year <br /> re <br /> erators fferor's Printed/Typed Nam <br /> g-6vi <br /> _r 16,International Shipm n ❑Export fro U.S. Port of entry/exit: <br /> F— 0 Import to U.S. Date leaving U.S.: <br /> Z Transporter signature(for'exports only): <br /> W 17;TransporlerAcknoWedgmentofReceiptofMate"Is, nature Month '-Day Year <br /> i Transporter-1 Pdn yped Na <br /> a \ ( Signature Month Day ea <br /> QTransporter 2 P nted yped Name <br /> 18.Discrepancy <br /> 18a,Discrepancy indication Space 0 Quantity OType <br /> ❑Residue F1 Partial Rejection Full❑Full Rejection <br /> s <br /> Manifest Reference Number: <br /> U.S.EPA ID Number . <br /> 18b.Alternate Facility(or Generator) <br /> V <br /> tai Facilitys Phone: Month Day Year <br /> U.1; 18c.Signature of Alternate Fadlity(or Generator) <br /> a , <br /> j z <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 4 <br /> w 1 2 3. <br /> O <br /> 20.Designated Facllity Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except a de i Item 18a Month' Day Year <br /> t Signature <br /> Printed.l ped Name F <br /> EPA Form 870 22 Rev.3.05 Previousi obsoleter, <br /> DESIGNATED FACILITYTO GENERATC <br /> 74 <br />