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Please prink or type;{Forrn designed for use on elite(12-pitch)typewriter.) <br /> Form Approved,OMBNo.2050-0039 <br /> �4,. UNIFOR A2ARDOUS 1:Generator ID Number 2.Pae 1 of 3 Ernee c R s <br /> , MANIFEST ( t (•'f�+ g1 mp x y�,pppsetf e 4 ManifestTrackin Number <br /> ' 06062139 SKS <br /> Geator s Name and Mailing Address Generator's Site Address(if different than mailing address) <br /> Al, - 8 tetea <br /> tt a e, �ADE�, <br /> 1953 0 est SUS r'O'01 d R �t,rt S rr�1� hr h `a''i t,1 _�taar11'+ r d R <br /> 'TRACYC. <br /> 9S@7 7 <br /> �r��� �� f ��F2 .��,••P'�€� �rs�Et <br /> Generator's Phone:. c„ ; <br /> 6 <br /> GA r r, r" rN'Tf <br /> Tans <br /> SYSTEMS INC U.S.EPA ID Number <br /> >.;fwl�vtec.l�,Coda � �e <br /> ` <br /> 7.Transporter 2 Company Name <br /> US:EPAID�umbe��} � ` <br /> 8.Designated Facility Name and Site Address r� <br /> RAFETY—KLLEN SYSTEM, u4c, U.S.EPA ID Number <br /> 6000 88TH STREeT <br /> N TO04 qw <br /> 916-306-4913 <br /> L:r��t0��0 i� 4 2,7 <br /> FacilitjfSP_hone; _. , _ <br /> ga, 9b U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10Containers <br /> HM and Packing'Group(if any)) . 11.Total 12 Univ 13.Waste Codes <br /> No. Type Quantity WtNol. <br /> 1.'NGr US UA T s LIOUID �k, f x:34 <br /> o ; (AWEBUS PARTS UASMEO SOEUTION) <br /> -UJ1 I7�1 20 <br /> Z 2. <br /> UJ <br /> 3. , <br /> 4. <br /> 14.Special Handling Instructions and Additional Information )- , :SCA 700 13S7 r t f" y{x , R <br /> #' y� HR VI I UNC Y <br /> #} * 84l-448- t60 ?Cft Try) fi' <br /> � t: f—FOR Y 6EN TO �MY1 LICENSED 811B CIIA pIE x I�T � <br /> 15. GENERATOR'S10FFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fullyand accurately described above by the propershipping 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 EPAAcknowledgmentof Consent. f <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am alarge quantity generator)or(b)(if I am a fnalfuanti <br /> q ty generator)is true. <br /> Generator's/Offeror's PnntedlTyped Name Signature 1 -Month Day Year" <br /> —i 16,Intemalional Shlpmgnt `�.; <br /> Z Import to U.S: Export from U.S. <br /> Port of.enlrylekd: <br /> Transporter signature,(for exports only) Date Ieawng U S: <br /> w 17.Tract'sporterAcicnoviledgmentofRecemtofMatenals <br /> O <br /> Transporter;1 Pfited/Typed Name } ignatur <br /> :Month Day : Year <br /> M <br /> Tra 2 Pnntedtr ed Name fa <br /> � --Signature <br /> :Month Day Year- <br /> F- <br /> 18. iscrepancy <br /> 18a.Discrepancy Indication Space Quantity F <br /> Type El Residue a Partial Rejection ❑Full Rejection <br /> Manifest Reference Number: , <br /> 18b.Altemate Facility,(q'96n U <br /> S.EPA ID Number <br /> x. <br /> Facility's Phone: <br /> U18c.Signature of Alternate Facility(or Generator) <br /> Q Month Day Year <br /> Z <br /> N19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> w 1 <br /> ('I14"1 2' 13. 4 <br /> 20,Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Printed/Typed Name <br /> 6jy" Signature �ry t r — <br /> M Day Year. <br /> EPA Form 8700-22(Rev.3.05) Previous editions are obsolete. <br /> `.�. . .. 1, " DESIGNATED FACILITYTO GENERATOR <br />