COMPLIANCE INFO_2018 - Laserfiche WebLink

Home Browse Search

SSL SK SHIP# 2eG358630 II1IIIIII11111II1IINII1III1l1illll ll 0063915915K6 Please print or.type.(Form designed for use an elite(12-pitch) pewdter) Form Approved,OMB No.2450-0038 UNIFORM HAZARDOUS 1.Generator ID Number C�Dg��y � 2.Page.1 of 3.imegg RespapSe P�rap 14-[danfies!Tracking Number WASTE MANIFEST 77 'fb[3-1 t 00639,1591 SKS 5.Generator's Name and Mailing Address Generators SileAddress(if different than mailing address) Cal—Trans Shop 10— Lodi Cris 845 E Pine St LOD I CA 95240-31@8 Generator s Phone: 209-333-5953 6,Tn§Wff f Amff p1M SYSTEMS INC U.S.EPA IG Number TXR0t�0081t205 7.Transporter 2 Company U.S.EPA ID Number a.Designated Facility Name and Site Address SAFE iY—KLEEN OF CALIFORNIA U.S.EPA to Number 6980 SMITH AVE. NEWARKs GA 945fz0 CAD380887413 510-795-4400 Fac+tin's Phone: ga, E'o.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, IQ.containers 11.Total 1 12.Unit 13.Waste Codes Hf,, and Packing Group(ifarty)) No. Type Quantity, wtNol, 1. MOAN RCRA HAZARDOUS WASTES LIQUID TT G 133 F5 ETHYLENE GLYCOL SOLUTION (LESS THAN, 5WI-) — - col -5- 2.2. LU 3. 4, 14,Special Handling lnstmctions andAdditlonai Intomtatian TSD:Ek]G 778037 CA47958 201835 CSG:1 24H E1IERGENCY#900-468-1760—CH/SK/TFI—Contract r1atained by generator comers a er an initial transporter to add or substitute additional transporters an enera-• 15. GENERATOR'SIOFFEROR'S CEfRTIF1CATION,.1 hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are class'if'ied,packaged. marked and labdadlplacarded,and are in an respects in proper condition fat transport accardingtd applt able international and national govammentai regulafiona If export shipment and tam the Primary Exporter,t certify that the contents of this consignment conform to the terms of the attached 1 PAAcknmatedgment of Consent I certify that the caste mirtimization statement identified in 40 CFR 262,27(a)(if t am a targe quantity generator)or(b)lilt am a sr9all quantity generator)is true. General ernes PdnledlTyped Name Si�neturec N. Month 'Day Year t .International Shipments ❑Import to U.S. ❑Expo+t'trom U.S. Pad atantryle : Transporter signature(for exports only): Date tsaving 17.Transporter Acknowledgment of Receipt of Materials Transporter 1 dnledlTyped Name Signature Month 77Day Year a C � G� /0 Q Transpoder2 rinled/TypedName Signature Month Day Year t-- A8.lh=epancy 18a,Discrepancy Indication Space ouantay ❑Type ❑Residue ❑Partial Re ectlon yip j ❑Full Refection Mantles!Reference Number: 18b.Altemate Facitily(or Generator) U.S.EPA ID Number U Facility's Phone: 18c_Signature of k1temale Facitity(or Generator) Month Day Year 4 2 19,Hazardtws Waste Report Management Method Codes(g.e.,codes for hazardous waste treatment,disposal,and recycling systems) LU 3. 2. 3. 4. 20.Designated Facility Owner or Operator.Certification of receipt of hazardous materials covered by the manifest except as nuked in Item 188 tedlrypedName Signature htonth Day Year Prin EP4iFq 4Q-�&�r 5} Previous editions are obsolete. DESIGNATED FAOILITYTO DESTINATION STATE(IF REQUIRED)