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�38L. sk SHIP# 21209021`PT <br /> Print ar tYPe.(FOrm desfor u6e on a to(12-pici, � MAN11111�III III <br /> L UNIFORM HAZARDOUS 1,Generator ID Number �typ wt4w.) C7 � 5 6 3 1 7 P C! 5 IC S <br /> WASTE MANwm Cu 0 982 S r z 2•t�agg,1 of 8..E Form Approved. %o OMB 2054-0039 <br /> a3�� r y V'"'tf 4.M IftstTrwIld rg Number 17 (� <br /> GelterIi Name anriMadingA�iress V C�! V <br /> 41 D-T 1^d f3 S S.10P I()­ Lodi curie ator s site Address¢if SKS <br /> different start 5 <br /> 1dq " B 3'a�Fs She morngadssj <br /> 8-ro 'rON ais hop if)- Lerli <br /> W-Phone: CA 95206 83 4 <br /> U.S.EPA lD td�mbar ,:• -- <br /> 1-Tra-W&Or 2 company Naw 3 X.8000 0 <br /> U.S.EPA ID Number <br /> s.assi�natedeii;ty'�ameandsrt�gdess AF .- STft ;, <br /> 6 88TP STREFT <br /> t5 INS vs.EPA ID <br /> r 16-386-401; AI'RAMENTO CA ? <br /> Faczklys Phone: 5828 <br /> 9a. 96.U.S.DOT De rlpiton tinct dng Proper Shi <br /> HM Snd Padang tmpCd any)) Pp 7 Name.Hazard Ctass,ID NurnbBr <br /> ta.Containers it,Total 12.tJt1Ft <br /> 1. NON--CRA HAZARDO 9 WASTE: � I£��J:� No. Type Oaamityo wtnFw. ta.ftstaCodes(AGUE US ,BRAKE LEANER) DF <br /> Lu <br /> #4 <br /> a 2. PION-RCRA HAZARDOUS UASTE, L IQU11) <br /> (AQCIEOUS PARTS WASHER SOLUTION) } L111 <br /> 3. <br /> 4. - "- - <br /> i <br /> i <br /> 14.Special Flarrrli Irrin pts and Additional Inforrnaliort TSD:SC:A • Z f <br /> 1T€3 : 7414 20iaSS .2S <br /> RGENCY <br /> Al1T�i A "A ENT �' GEN Til rtETAIN LICEl SED SUIR �€�ri3�IERE r�8 AGE SAS€ <br /> 35. GRIVTQR SK?FFEf?4R'$CEtiTtFtCATN: 1 herd <br /> marltEd and ia6elesll y i&re tftat the conterttg of tt€s co tsigntneni are firgy est#acctuatety rieserred above <br /> placartin and are in aA respects in ptoaar oondrf r n far transpcet accordir ij to appl c�a intatnationalat d t#onar sh pp ng name,ani are <br /> I comfy l�rgfy that rhe cantetsis trf this rArtsignment eanicrm to the temrs of thea Banat 9orremmental reguiabns.If a rt s d I am t d,p rmry <br /> I Certify ilial lire areata rriirzimizatiort stmerxrent idsntifreti in 49 GFft 262.27(a)(f 3 am ached EPAAGrr>E�ted�nt of Consanf. � ttrpment and 1 am the Primary <br /> Oanerata�aJC3fror s Pri Typed h generatcri u(h);d t asm a s r aiI quantay ratm}is hie. <br /> S gna�rre <br /> G.tn3anzat*4 shiptents <br /> Day Year <br /> Transporter signature(For experts O*); Imporr:oU.S. Q Expori from U.S. part of errtryJ _ <br /> IT Transporter <br /> o• of Materials <br /> or 1 PrinledJiyped <br /> as � Signa <br /> Transport tpadNar }� JYe`a'rr <br /> � Sigrta�ra 1 t ! <br /> 18.Dsmontl Month Day Year <br /> 19a.Discrepancy ftuliCatiENt -ce <br /> E.1'^l ❑7p4N <br /> Res Cue l—tL } f� <br /> Partlai.{isjactiory FullRejed€on <br /> tBC.Aftemate Far�lity(or Generasiri f�tan fest ReferanCe Number: <br /> t.T U.S.EPA 1D Ntattber <br /> Fa€akiys Ptwna <br /> I Sc.ftnature of. y(pr Gerle+aw) <br /> Month Day Year <br /> 19.Hazardo rs Westa Reportbtana9elhafit MOD"codes f.e.,codes for hartn3n;y waste beatrneni, <br /> I 2. sposal.anc recciing sysl:Lmsh <br /> 3. <br /> 4. <br /> 20.Designated amFacility Owner or operate, <br /> NautCertilation of receipt of hazardous tles,rnahxiaa covered by the manexcept as naiad in!tarn 18a <br /> yited a <br /> ,t� igraiut2 <br /> (/ -7 �'1�` 'month Clay Year <br /> EPAF 79FIM C ESiG ATiE[3 FAC!!.lTY To 5TI 3t+1 STAT <br /> 79 <br /> �� E{IF REQUIRED) <br />