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SK SNI # V29963714 <br /> 'v <br /> Form Approved.OMB No.2050-0039 <br /> aRDOUS 1.Generator ID Number 2.Page 1 of '3. me R spy a Pig 4.Manifest Tracking Number �� <br /> CAL6100346875 e- � 1 r�10 <br /> .,ANIEEST <br /> (or's Name and Mailing Address Generator's Site Address(if different than mailin atldress) <br /> e) SA -� 1'titn 'Ge AIaESA Golden Geste <br /> 15501 W 'strStanfortd Rd Attn Samuel Mchenhy 16 1 Stanford Rd <br /> TRACY - CA �lI I TRACYL�ste�^ Sabo CA 95377-9708 <br /> Generators Phone: �9�•µ '^.3882 '', <br /> s.Tr �ppcter �pmp�n SYSTSP�S INC us.EPA J.D.Number TXR0800812 <br /> 7.Transporter 2 Company"f4ame U.S.EQAID Number <br /> CLEANN tl i RS ENV SVC INC. A MAD�3938225a0 <br /> 8.Designated Facility Name and Site Address=es C4.-A IARSi3RS '�!1TTOhlW I l L OW U.S.EPA ID Number <br /> 2500 LO�{ERN ROAD r <br /> SUTTOWWILLOW ti , CA 93 <br /> -76P-6200 CAD9180675276 <br /> Facility's Phone: <br /> 9a 9b.U.S.DOT Des&Aol n(including Proper Shipping Name,Hazard Class;ID Number, 10.Containers 11.Total 12 Unit 13.Wasje Codas <br /> HM `and Packing Group(if any)) No: :' Type Quantity Wt Nol. <br /> 1 3gP1-- ,HAZARD WASTC9 G ` 114O <br /> US <br /> L EXAUST FLUID)sft <br /> 49 <br /> tZW7 2: <br /> a> <br /> 3. <br /> 4.. - <br /> ti <br /> 17 <br /> Special Handling Instructions and Additional Information TSD OL 164S6EI6 ADi?� S <br /> �i � <br /> 24H. <br /> EMdBtWCY#800-468-1760-CH/SK/TFI"Contract7 retained by generator co zFers a�ency auh ar'= "y <br /> o a iti r`'ns rite a or substitute additional to addo a tra so to s o enera ®r9 s .be 4lf.` <br /> :1&-,XGENERAT,OR'SIOFFEROR,SCERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified packaged c <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 eptents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent, I` ` <br /> " M, I cerU_fy tha e'waste mm'Irii nation statement identified in 40'CFR 262.27(a)(if I am a lajite quantity generator)or(b)(if l am,a small quantity generator)is true: <br /> o ?nh)"IfTyped Name Signa u _ r r Monthg Day Year <br /> a 1 V. <br /> F <br /> ntemaU ❑ImporttoU.S. Port of entrylexitnsporter signature(for exports only): Date.leaving U.S� TransporterAcknowledgmenf of Receipt of Materials <br /> LU <br /> 71 Printed/Typed ame natureont (Day Year <br /> a s -40 <br /> ransporter 2 Printed Name. ogth ay, ,Year; <br /> b $ f 3 <br /> t-- <br /> l (. <br /> 18.Discrepancy` �• <br /> 18a.Discrepancy Indication Space v fi <br /> ❑ Quantity ❑Type ❑Residue ❑Partiai Rejection ❑Fuit Refection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator), U.S.EPA1D Numbef, <br /> < Facility's Phone: <br /> W 18c.Signature of Alternate Facility(or Generator) ; Month Day Year. <br /> Q <br /> Z <br /> N19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 3. 4. <br /> d <br /> 20.Designated Facility Owner or Operator:Certification of recelgof hazardous materials covered by the manifest except as noted itritem 18a a <br /> Printed/Typed Name Signature' ,_ Month Day Year, <br /> 6( A,/r <br /> EPA Form 8700-22{-Rev 12-1.7) Pr vious editions are solete.: DESIGN ED FACILITY TO GENERATOR <br /> Z)854.7779 i7S?@lag <br />