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-� SSL SK SHIP## 221625a2l <br /> 005 ? 42651sKs <br /> Please print or type.(Form designed for ase on elite(12-pitch)typewriter.) f=orm Approved.DMB No.205M38 <br /> t GswaW ID Number r <br /> tJNIF01tM4HAZARt70l3S GAC}45�4€�535'� 2.Pag$1A 311-11"Plern?(? d.YanlfestTracicgPlumbar <br /> t,WRx WASTE MANIFEST 1005742658 urS K(� <br /> Gene atoYs Name and i 1g Ares Gen for s Site Ad@nsss t+f inapt rtaatirr�address <br /> CMZ Trans top � - Lc►tti 2 -Trans�t` 1 . a t 0 , <br /> 14503 5 R est 845 E Pine St <br /> STOCKTON CA 9S206 <br /> Generawes Phme: 2017-333--5953 L ODI CA 95240--3100 <br /> 6.T�de�l�ar� �e SYSTEMS, 3:NC. U.S,EPA IONumber TXRt}E}{}081205 <br /> 7 7ranspodw 2 Compsny ulama U.S.EPAEPA — .� <br /> a.DesignatedFadAyName and Site Address SAFETY-KL.EEN SYSTEMS, INC. U.S.EPA iDNumbw <br /> 6000 88TH STREET <br /> SACRA"ENT.# CA 95828 <br /> Far"" s PhDAe! <br /> 9a. 9b.U.S.DOT Nscrl*n(Nu609 Prcpet ShfOng iNaame,Hazard Class.ID Number, IG,CentairprS 11.Tout 12.Upit <br /> HM and Padang Group(it any)) 13.Waste Codes <br /> Lt Type Quantity Wt.Nal. <br /> No. <br /> 1. NOK- CRA HAZARD WASTE, E100IC � TD In ype <br /> I�$ <br /> o _ <br /> Z 2. — <br /> � (AQUEOUS PARTS WASHER SOLUTION) � DM 13 <br /> 3. <br /> 4. <br /> E <br /> E <br /> 'In* IC Sal Handimo tnstructiom and Additional Worrnatpn s <br /> 01710 CSO <br /> 34 !-4Ft EMERGENCY #1-800—$69--1760 (SSC r TF3} <br /> Z j <br /> RUTH AS "AGENT--FQV BY CEN TO RETAIN LICENSE} S4}B CARRIERS AS NECESSARY <br /> 15. GENERATQR'S10FFEROR'S CERT3MATIW. 1 hereby dedwe ftt l is oardents of tit's consignment are laity and atxuiateiy descrided abrrve by the proper shipping nerve,and are ctassrRad,paeka*. <br /> marked and labe!edlplaoarded,and are in ail respects in pros;oars �on for transport a=rd`irg to apocabte in'emational and"VorW govemmsntal regrdaauns.It export sh*merrt aW f am the Primary <br /> t:VOAer,I certify that the wn`lants otthis mnsigrmettt cantorm to the temps of the attached EPAAcknoMedgment of Co+>,sept, <br /> ertify that the wash mMizatior3 statement identified-n 40 CFR 262.27fa)(i'I am a€arge quantity generator)or(bi(01 am a small qualk generator)is hue. <br /> Genaratat s Offerors Ptintsd.+Typed NTw S4riatura <br /> ra A ay Yar <br /> r 16.intematlanal Shipments <br /> IN- Qlrrrparttou_s, ❑Evwtf.U.S. Port at ;exo, <br /> Transporter skjwti a{tot expo s o„tyf; Date U.S.: <br /> 17.TrarisperterAdmowiedgment of Recept of A>;aterials <br /> Tra er 1 pw *Name Sir ature Mordtt Lay Year <br /> 0 P!4 <br /> = Tran T ped Name Sigraturff Month day Year <br /> FCAL <br /> 161 / <br /> 3.Discrepancy <br /> Ifla.Discrepancy€ 4Rtiah Spate El <br /> 17r—� r 1 <br /> f3vanbt LJ <br /> ..J Type iResidue ❑Aartia=Rejetticn ❑Fut'Resection <br /> ManifestReferencs Number. <br /> l8b.Aft err ate Facility{w G"caloi) U.S.EPA ID Number <br /> Facitfys Phone. <br /> LU i 8c Signature of Allomarte FacNty(or Generator) More Day Year <br /> 19.Hazardous Waste Repan€Management Mmod Codes(l.e.,nodes for hazardous waste treatment disposal,and recyQing systems) <br /> LU '' H 141 2. H 1 X41 a. 4. <br /> E <br /> nated Fatffity Omer or Qpera;or.Certification of receipt of hazardous maL-riafs covered by the manifest except as noted in item 18a <br /> acne � � h�nlh Day Year <br /> EW"M3111 ps t g s rt r �. rMSI& AT D FACILITY D ION STATE(IF REQUIRED-1 <br />