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5�i'- 5" �jH1FR eeYVU2061 O'f'( IIIIIIIIIHIl111111iniiimIIIII Please print or type. 0 0 7 Form Approved.OMB No.2650-0439 UNIFORM HAZARDOUS 1.Generator ID Number CAR000055301 12.Pagilof tE Y wfSi1 geo 4.Manifest Tracking Number WASTE MANIFEST SKS 5.Tirnea lo Nme�d�tN�ailing Address Generators Site Address(If different than mailing address) 3450 Auto Plaza Pkwy TRACY CA 95376-0400 Generators 8009ma-830 3642 8.a`Rr t �REEE SYSTEMS INC U.S.EPA ID Number TXROOOOS1205 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address OF CALIFORNIA U.S.EPA ID Number 6880 SMITH AVE. NEWARK CA 94564 510-795-4400 CAD980687418 Facility's Phone: ga 9b.U.S.DOT Desaiphon(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes flM and Packing Group(if any)) No. Type Quantity Wt./vol. 1- NON RCRA HAZARDOUSTT G 133 0 0 ETHYLENE GLYCOL SOLUTION (LESS THAN 50%) �} z 2. W C7 3. 4. 14.Special Handling Instructions and Additional Informatkm TR 4107 201948 CSG: 2 34H EMERGENCY#800--468-1750-CH/SK/TFI-Contract retained by generator confers aggency authori on initial transporter to add or substitute additional transporters on enerator's behalf. 15. GENERATOR'SIOFFEROR'S 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, marked and Iabeledlplacarded,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 Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAACknawiedgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity,generator)or(b)(ill am a small quantity generator)is true. Generato rintedlTyped Names/ ' Sgnatu Month� Day Year 18.International Shipments I- ❑Import to'U.S. ❑Export from U.S. Port of entry/exit: RE Transporter signature(for exports only): Date leaving U.S.: W 17.Transporter Acknowledgment of Receipt of Materials LU Tra r PnntwOame Sig Month Day Year CL CL i Tfanspoof2 Printed d Name Signature Month Day Year F 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number. 18b.Alternate Facility(or Generator) U.S.EPA 10 Number J_ V LL Facility's Phone: W 18c.Signature of Alternate Facility(or Generator) Month Day Year a x 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) G 1. /41/ 2. 3, 4. 20.Designitaed Facility Owner or Operator.Certification of receipt of hazardous materials covered by the manifest except as in Item 18a Print Naamme�r Signatu on Day Year WrC12 17} Previous editions are obsolete. DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM