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RE !3htf-4 <br /> Please print ar tope.{Farm designed for use afs eliEe i2 ptich typaurler.J O 0 5 3 1 7 7 d S K 5 <br /> UNIFORM HAZARDOUS 1•G�lefeloriD Ntartber Falm Approved.OMB No.2054.0039 <br /> WASTE MANIFEST L l t?t � $ �t 2.Pegg l of 3..E 4. fhrstTraekt Number <br /> 5631 0 SKS <br /> r3eneralersfr a and Mating Address Generami s 3iteAddfess pI aireIt[Iran rrt&Qhm address) <br /> Cat-Tra1t 5top 1 - Lodi <br /> 1603 B B St Cf-Tf'ans -i#1op 3 G- <br /> STOCkrON CA 845 E Pine St <br /> �U9-X33'-6953 �x�L�� <br /> Tpn <br /> Genarat�"s Phme: r� _// <br /> 6 T rppa t..iFf1i .+k4 :r Lcf~_•.:Sr: 1 <br /> —tSfnM SYSTEMS, INCU.S.EPA IDNnber <br /> r.Treraporicr 2 Company Name <br /> U,S,EPA It)Number <br /> B.Deslgnaled edldy Nems and SMAd <br /> SAFETY-KLEEN SYSTEM-9. INC U.S.EPA IVNunoer <br /> 6000 88TH STREET <br /> SACRAMENTO CA ?S828 <br /> 916-386-4913 <br /> 9a, 96.U.S.D07 Descriplion fiddta*g Proper S1100 g NOR*,Hazard CII lD Number• <br /> HM witpaddrgG=P(gany)) 10.Can laineis 11.TOW 12.Unit <br /> No- Type 11.TO ly WtlVW, 13.Waste Codes <br /> 19 1 NUN-F URA HAZARDOUS -734 <br /> #3AST£, I. TQI1I� <br /> Dr <br /> LW z. NON-RUR HAZi�RQOHS b3AS'FE, LSQ!!IU <br /> cn (AQUEOUS PARTS WASHER SOLUT I N) y D I �d V ��4 <br /> 3. f <br /> a. <br /> i <br /> —' 14, al Ha rltgfistrt>cliotsardAdd' ailnPorrnatian TSps; Isf.'.� 74 1IC)F3r5+F CA7t}9 <br /> 24 HR EhERGENCY #1-800-466-1760 (SKr Tr:i) <br /> RUTH Asa` OAGENT-FOR" BY GEN Tn RETAIN LICENSED SLID CARRIERS �ASJE�MEQC-AR�q <br /> 15. GEF�RA70R'SlpFFFRtNt'S CRR 1 INCARGN:I hereby dlxtgre that tine contents of thfs consignment are fogy and aocuretely descsthed adore Ute <br /> marked and labate ftlacarded,and are in ail respacm in proaer cond'rfian far transport acmrdinB th app{�a6do kttentatla�Mand nations °°er sl op ng name,and are da551fied:parlra�d, <br /> E erfity II t he Thai the cunMa U W this m'16g MOM conform to the tear's 011 attefbed EJ1A go,rerrlmenlal regulations.If export strimnertt and!am the Pnnlary <br /> I certify that the w8I frdrrentcatiun sfalement Wr IIIIteo In 4e CFR 262.21 e i I am a of Consent <br /> (l( 3 ganeratcr}or(b)tiff am a small Quantify relor}is tnra. <br /> Ganeratorwoferor'sPd Name Signaiuro <br /> Ih D�DIP-I °ayy! year <br /> 8.Irrtefnatiane!ShlpntE(NS ;411 <br /> ( 7 <br /> Trans rter ri to U.S. L J Export from U,B: Part of entry! , <br /> Pe signaarra(fofexpodsrpdy} <br /> 17-TransporterAsyvlow,edgmant of Rawipf of hlodsirals Rate leaving U.S,; <br /> T 1 Prikr&-rypad e Signa <br /> Tram ame <br /> � Da � <br /> Tsa <br /> ` Sgnature Month 0ey Year <br /> 18.tlisrropency A.c � � <br /> tBa.Discrepancy Indiction Spam f]uand y ❑Type ❑Residue <br /> ❑PafiakRejaction E�^—]�L#Full R®jeI <br /> 18h.Aftamata F fhanlfesl Reference Number <br /> �Y is t3enerafor} <br /> U.S.EPA ID Number <br /> cs <br /> epi F.,WysPfrare- <br /> Mon18c.5�raSdreafAltemateFaciCity{orl',ettaratw) <br /> th Day Year <br /> 18.HuBrdous Warta Report Management R1e1Aod Codes(€.e..codas ar tlazardaus xas191featmonl dsposal,and recyd tg systems) <br /> 4. <br /> 1 . <br /> f 20,Das9ulod Facility Ownar or OPerabr Ceruftoon of apt dhazardun MaIer[ak COVII C Gy the Mftf OXCW 89 nM In gem 19a <br /> jlll ngrm Nam WEI Z-001t ,SIIIJrAre <br /> Ef}AFgfrq <br /> DESIGNATED E^ACII�ITYTO STI ON SPATE(IF FtfQUIFI !y) <br />