Laserfiche WebLink
f Form Approved.OMB No 2050-0039 <br /> Please print or,type.(Form designed for use on elite(12-pitch)typewriter.) 2 pa e 1 of E r e c e nse P,go a 4.10 anifest Tracking Number <br /> U RM HAZARD0 J5 `1 Ge�11eratot ID Numtie'r"^' 9 ! ? ' SKS ' <br /> Wp `MANIFEST <br /> 8.Generata's Name and Mailing Address Generator's Site Address(if different than mailing address) <br /> . Ct t `i or-d Rd AAP FS ."Mt Samuel �3t~tr r � �t tr t C f <br /> ,P., G S: 7 7 708 <br /> � . t i i a <br /> TRACY <br /> Generato?sPhone:' � 934 <br /> U.S.EPA ID Number € fA1 :% hta <br /> 6.E t etf'I IMP e 'Eng lot <br /> Us. <br /> 7,Transporter 2 Company Name <br /> U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address <br /> rEv"i Y" L ` SYSTEMS INC_ <br /> 6000 WK STREET CA 95828 <br /> KRM <br /> Facility s Phone: <br /> 10:Containers 41.Total 12.Unit 13.Waste Codes <br /> 9a. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, a Quantity Wt.Nol. <br /> HM and Packing Group(Ill No. Type <br /> o WIWI <br /> (€� 1J CfS PARTS WASHER SOLUTION) ! ��✓� `2 (� <br /> Z 2. <br /> W'. <br /> 4. <br /> 14:SpeciaiHandlinglnstructionsandAdditionallnformationTSP:SCAn13, )�` 19 9 <br /> 4 � <br /> } <br /> 4 F <br /> BY <br /> At- fit$", A i _ qtr # t i t t') C LAC` <br /> t "` # h '' iY. > Ca <br /> 15. GENERATOR'SIOFFEROR'SCERTIFICATION;•I hereby,declare that the contents of this consignment are fully and aceurate] a ribed above by the proper shipping name,and are classified,packaged, , <br /> marked and labeledlplacarded,and are in alt respects in proper condition for transport according to applicable international a na' nal govemmentai 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 Conse I. <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(i small nti generator)is true. Month Day Year <br /> Signature <br /> Generator's/01 a is PrintedFfyped Name . Jill '° <br /> _+ 16.in ernationa hiprttehts ❑Export from U S' Port of entrylexrt <br /> Import to U S <br /> r 'D61e leaving U S <br /> Z Transporter signature(for ezporks only) <br /> 17 TransporterAckpov{ledgment of Receipt of Maten@is Month "Day Year <br /> Sr nat4re <br /> ra. SPR er 1 Pnnte p � ii c r r�� <br /> Month Y <br /> � � ': M� <br /> Q Tran 2 Printedliyped Name <br /> Srgnatiire <br /> Day Year <br /> t- <br /> 18:' screpancy �. <br /> 18a.Discrepancy Indication Space � Quantity <br /> 0 TYPe ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> U:S.EPA ID Number ,,. fora " <br /> 18b.Alternate Facility(or Generator) ori- <br /> oa. Facilitys Phone: Month. Day : Year <br /> r W 18c.Signature of Alternate Facility(or Generator) <br /> Q <br /> Z <br /> f. 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal;and recycling systems) <br /> W 1. <br /> 2. 3. . 4. . <br /> t 1.4 <br /> R0.Designated Facility Owner or Operator.Certification of receipt of hazardous materials covered by the manifest erteepi as`noted in Item 18a onih' Day' Year <br /> Printed ed Name Sigridre <br /> tu <br /> A7ED':EACILITYTO GENERATOR <br /> I - SPA Form 8100 22 Rev.3=05) vious editions'are obsolete,' , <br />