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_ Sk SHIP4 224312937 111111111111 � I <br /> 0 06531654 SKS <br /> Please{rir11 cr t pe.i:Fomn desi nad for use on eMe 02-pitch)typewriter.} Form Approved.CA46 No.205G-.0039 <br /> UNIFORM HAZARDOUS ].Generator ID Number a 2.Aa$e t at E 4,h6anlfoat Trac[ring Nwoer {[ <br /> WASTE MANIFEST LAi?9�#t$8 r3�a� �—��� •r ' �rte}31654 SKS <br /> [gators Nina and MaiEm Adds= Genersta^s$trs Address(if different than magkV address) <br /> Cal-Trans Sh6p 10- Lodi Cal-Trans Shap 1.0-• Lud} <br /> 163SDSt 845EPine St <br /> STOCKTON CA <br /> G#naratoesPlyiw �- -b a3 LUDI CA 9sc40-'3.108 <br /> S5RMWSYSTEMS INC U.S EPA ID Number <br /> 7.hansparter 2 Company ac Name U$ EPA lit Number <br /> ti �ateit <br /> e. �sl� rytvarneancrSceA�ress SAFETY--€ LEEN SYSTEMS,, ?Nt,. t.s.EPA IDNumber <br /> 6000 BOTH STREET <br /> SACRAMENTO CA 99828 <br /> ► Ea-3 #6-4913 �,A0000084E r <br /> Faf�;i1 s Phcr+.a: <br /> 9a. 8b.U.S.00TDessxiPtirut iE?d0Jifl9 Proper Skipping Name.Hazard Cuss.In?number. ?4.CcnCa Hers t?-Talal 12Ctn€ <br /> Hs; and Paddng G-p 11-y)) . 13.Waste Cc Oes <br /> 1 No. Type Quanllty Wt&W <br /> 0 ( ;� <br /> �-NON-RCRA HAZARDOUS WASTE, LIQUID �- � X34 <br /> �AQUEUUS `ARTS WASHER SOLUTION) � rc' a� �.._...__._. <br /> D rvy j <br /> 3. <br /> 4_ <br /> t <br /> ?A.S;tEai Harting InstntOws and AddW%l l dontra+l* TSS.SCA 7 8,695 1 M37092 2-40183 CSS: <br /> 24 HR EMERGENCY #1-800-468-1760 (SK t TFI) 1 <br /> AUTH AS 'AGENT-FOR" BY GEN TO RETAIN LICENSED SUB CARRIEP. AS NECESSARY <br /> 15 GFNEU'rOR'SIDFFEROR'S CERTIF CATION: I hereby dare that the contents of the onnsigttmgnt are fu§y and ascarakly daSUUd above by the prow shipping name,astdare classified,packw- <br /> marked and lab&,dip€acarded.and ase m akl respW4In pr wr oandi w for tmwd according W apPGoab€g InternaWMIand nafio ar gaaemnenlat regulaWns.If ehpat shipsrwt and I am the Primary <br /> Exannor,I sert�fy that the contents Of this wnsigmMIT conform to the terms of the allached EPAA&ro-Mettgrrtnt of Consent <br /> t cedt/that the waste rni€y k:n M 4Tant ide<?%M in 4 CFR 262.271a)trf 1 am a large quantity genera:er)of(b)Idl am a sma!i qan,Ay a tori is truo. <br /> Gesarato?$. r edfivp ame Signaturr month—Nv Year <br /> —r 16,Internationa;Shipments <br /> ❑ t Co U.S. ❑Euport from U.S. Port d entryexit: r �._.�._._..._.. <br /> Trspurter s�gnatum rfar expu#s onlyp-. Jata leaving U.9.: <br /> W ?7.€ranspw?er Ack x"*:fgmerr.of Receipt I Materials <br /> Trp rler?PrintedfT Name Signature Rtoil D sew' <br /> 00.' i <br /> Tra spa P ted! ed Name Signature FAINt. Day Lear <br /> r <br /> F— <br /> ?&a.Heaney lndre nw Specs # {� <br /> QuanGtp Tae LJ Revd�e t_.Parts!Re;ecsan L Full Rc e-,vP, <br /> klanites:Refers,�ce Number: <br /> t ,Ai`cnrP.alE F3Liliy i6r G0!'t2r8`.df) ULS EPA IC)Number <br /> C.= <br /> Fac ty's Phone. <br /> W 18c 3na&raoiAltemateFootN{orfe eratorl blanch Day Year <br /> er: <br /> 1$.Naz&rr#a;rs Waste,Racrart kienggenlao Method Codes(i e.,codes far hamdoes waste treatment,disprsal,and rar;Oing systems) <br /> ELI <br /> H141 T4_ <br /> :G.peo goatee raafity(hr�r a Dporata:Car?ificatwn of receiai of hazardous rra'er iM5 covered by the rnanfEst except as ndad i hem 18a <br /> PR Tjped Namef f Signature t th Cay <br /> tf F rtt O <br /> Fly n e ESiGNATED FACILITY TO `FSTi C3 tTATE(IF REQUIRED) <br /> �` '� <br />