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,.a <br /> SK SHIP* 225735N9 !`. <br /> H. <br /> Pleaserint or, <br /> p type.(Form deslgtled for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 <br /> 1 Generator ID Number 2,Page 1 of 3.Emer enc 'Res onse Phone 4.Manifest Tracking Number <br /> UNIFORM HAZARDOUS <br /> Ct� 31�S77S 1 1- -4 B-1760 <br /> W 7L MANIFEST � 7 FLE <br /> •'.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) <br /> DESA ^ Goldenate AMEBA - Golden Gate <br /> 18501 Chest Stajord Rd Atte Safikqel Mc:henry 1a5@1 Stanford Cid <br /> TRACY ,, CA 95377 Attn Lester Sabo <br /> Generator's Phone: �4"`5374 TRACY CSA 95,377-97@8 <br /> 6.Transporter Com any Name U.S.EPA ID Number <br /> SAC ET LEEN SYSTEMS INC <br /> 7..Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address r-ETV— LEEN OF CALIFORNIA U.S.EPA ID Number <br /> 6889 SMITH AVE. <br /> 510-795--440-3 NEWACICO v CA 94560 CAD980687418 <br /> Facility's Phone: <br /> ga, 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13,Waste Codes <br /> HM and Packing Group(if any)) No. Type, Quantity Wt.Nol. <br /> rr114911 9 <br /> o� t <br /> Z2UJ <br /> ,I `; s- , <br /> �y " f a <br /> TT 4- <br /> 3. r��) <br /> 4. <br /> 14.Special Handling Instructions and Additional Information <br /> TSX)EVS A020190 CPS.; <br /> 4 HR EMERGENCY 01-800-468-1760 (CH 94-;/ TCa I I t �� <br /> aumj as rr <br /> 15,_;GENERATOR'SIOFFEROWS 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 cert; th con of this wMm ent conform to the terms of the attached EPAAcknowiedgmgm of Consent. - <br /> I.certityThat w ste minlmlzat,66 s ement Iden fled in 40 CFR 262.27(a (if I am a large quantity generator)or(b)(if I am all quantitygen ator) rue. <br /> Gen ators rors d/Typed ame Month Day Year <br /> 12Y JIS <br /> ri16.10mational Shipments <br /> F" ❑Import to U.S. ❑Export fro U.S. „ Port of entry/exit: <br /> Z Transporter sinature for exports only): Date leavin U.S.: <br /> W 17.Transporter Acknowledgment of Receipt of Materials <br /> LLI <br /> 1i Tra, orter 1 PrTnted/ryped Na"e i atur Month Day Year <br /> IL <br /> Transporter 2 Pri ted/Typed Name Signature Month Day Year <br /> h <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space Quantity ❑Type ❑Residue ❑Partial Rejectionj <br /> EJFuil Rejection <br /> Manifest Reference Number- <br /> --.. n � . ... <br /> _ 18b.Alternate Facility(or Generator) U.S.EPA ID Number "+ <br /> LLFacility's Phone: <br /> H18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> Z <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 0 1' t 2. 3. 4. <br /> AIM <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 Namo i t d Signature Month Day Year <br /> j�, fl s <br /> EPA Form 8700-22 Rev.3-05) Previous'edition are obsolete. DESIGNATED FACILITY TO GENERATOR <br />