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SL SK SHIP# z2o9o2197 1111111111111 �11� 1111111111111 <br /> Please print or type.(Form des6 ned for use on eiite{12-pitch)typewriter.) a a 5 6 3 9 7 7 0 S K 5 <br /> 1.Generator ID Numt,er Farm Approved.4MEI No.2050-0039 <br /> UNiFOR141HAZllitt3(?U5 LADS 4SS3Si 2. 1of 3..E tttfNumber <br /> � Y' a 4.Matlffmrsf Tracks <br /> Ys(ASTE MRHIFEST <br /> Genwatv's dame Sed Mai?3ny Address 5631 77n KS <br /> Cal—Trans 3hOp 10— Lodi £enera!?fs SiteA.ddrese pt dent Ulan ftftV Q1ilrass) <br /> 1603 a g Sat Cal—Trans Shop 10-- <br /> STOCkrtm CA t E2 84S E Pine St <br /> e2.09-333-69 3 `� aLl1@ <br /> Gar+era(m's Alaxta; :"A <br /> fi.T , SYSTEMS, I#3f, O.S.EPA @Number <br /> Y�`s�.00�1�18 z2+��' <br /> 7-Tratts{tur3er 2 Company Nanhe <br /> U.S:EPA ID Number <br /> B.Designs€edF9tB3Name SiteAftes9 SSA ETA-9LEEN SYSuTEN' '•;, INC U.S.EPA ID Number <br /> 6000 88TH STREET <br /> 'Ple,-366-4913 SACRAMENTO CA 75828 <br /> Fadi sinhorc LLA0000084SI7 <br /> 9a. 9b.11.5.DQT t tion(including Prppar-%PPN Marne,Hazard Masa:ID Number, 1 <br /> 9 e rd any)) t)-Ccn1a ears <br /> HM and A 11.Total 12-Urtlt 18.��Codes1 NUN- KCRA HAZAfiC}t1US WASTE, LTGUID fro, TM ttuantliv uvt�roa. <br /> a (AQUEOUS BRAKE CLEANER) � � a i 34 <br /> w <br /> 20 <br /> x z. MGA#—RCi�TA .1AZAf:?1 t5 lJA�s'IE, L UI f`= <br /> tF QilEaIIS PARTS l�ASu S€1-iJTi0N; <br /> 3. <br /> , <br /> 14.5pecial Harui jg jsI uC I'trs and AddWria!!nfoama!ion <br /> a�4 HK EMEfat3ENCY #1-800-4_68--1760 (Sk .f 'TFIt <br /> € F <br /> UTH AG ""GEN -FOR" BY GEN `T€"i RETAIN LICENSED G- F <br /> 15. GMERATOR'SOTEROR'S CERT14-1CATION:i hereby declare tfrat the contacts of this CORS19[m 't afe WHY and accuratey descrbed above b the r eta <br /> market and labele ftlacarded,and are in all respects in Pro„er condition far trafiSport accords to y t> Tanta,and are dassi€ d:packaged, <br /> Exporter,'certify that the aWolts of ft aon0Fff `l ca*m to the terms of 8to attached EA aP(tid abl mart ratwatat and rkrtionc gpVemmenlal regular+ons.If expert shiDmerd and I am the Prmary <br /> r c6rdrY that the waste nmhrrcni-r�tion stalernent ideribTtad in 4(3 CFR 262.27 at 1 am a€ Acffeilgmermt a co 'al <br /> ( ( large tuanN,,y generator)or(b)(j,am a small quantity rator)i5 hue. <br /> Genamloesi0fferor s p f adFfyI Naar Signature Montl1 Day Year <br /> &.Inhemato t&hiprrmeras d <br /> Transporter s' tura fore rte Li <br /> Import to U.S. ❑Export from U.S. port of entryte <br /> 1?.TraTwPofte''AdmowWgmwt of R <br /> '�`at of Materials <br /> �S T t Prir ecyPed a S,natu p <br /> �j f a 1-r <br /> rens ypad Name Signah,re <br /> Month Day Year <br /> 1$,Ds�epancy <br /> 180,Discrepancy Indne on Spada ❑Type ❑ <br /> Fyriab>IRy+ ❑Residue ❑Pafia1.F(mtjactian Ful] <br /> 18t.Alternate Fackty(or GeneraW) Manliest f{ett]coca Number: <br /> U.S.EFA ID Nratlber <br /> V <br /> Faciklp`sAhnrma- <br /> 18C.Signature of bJterrt�e Fadktp(or Grata} I:lnrmth Day Year <br /> ca 19.Flazardo is Waste Report Management R1etflod Cortes(i.e.,aides fir tmezardous vrast8 treatment dispdsal,and recyc>r€ag systems} <br /> H141 T <br /> 1. <br /> + ' <br /> 2b.o9sgnatad FaciSty owner or CPoramr:Certifwatiort of receipt of hazard=nta€er(laI$COMM by itis mantes,VOW as nded in Rem f&a <br /> .n y*Name <br /> Signature <br /> 7 -9,F?7� -z— <br /> s Y Year <br /> Ei'AFom <br /> EVAN �V 4V �. iJESfG ATE[]FAGifriTY TC3 5Tt QN STATE(!F REQUIRED) <br />