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SSL SK SHIP# 21625321 1111111MINIMUM <br /> 0057426S35KS <br /> Please print or"a.(Farm des' sled for use an elite(12-pitchy pewr€*.f yam AGRroved.OMB Nu.20511,039 <br /> UNIFORM HAZARD= 7p=1 3 _105742658 <br /> 4. <br /> 1€'tia WASTE MANIFESTCRt}98485351 D D 5 7 4 2 6 5 8 SKS <br /> Otter 21'r1me aild�ih go cane tors�a�adracs(rFd amp,eating alr s� <br /> GdZ�-Tr�11S p�0- Lodi �aI- rangy S�10 - tt i <br /> 1503 S B St 845 E Fine St <br /> STOCKTON CA 45306 <br /> GaneratoeaPhm: 2017-333-695 1 L.ODI Chi 95240--3108 <br /> s.T T"KLi�SYSTEMS, INC. US.EPA 10 Number TXRODL1b61 X05 <br /> 7 Tmnspo ter a Company Name <br /> U.S.EPAIC7�N <br /> S.D*naladFacility Name andW Addraas SAFETY—KLEEN SYSTEMS, INC. US.EPAIDNumt:er f11 <br /> 6000 89TH STREET <br /> FWs Phone: SACRAMENTO CA 9588 <br /> 918-386-4913 CA0000084517 <br /> 9a. 9b.U.S.DOT Vm to f inGIL 5ng PmW 5l Pft Name,HUM Class,ID Number. 10.Containers 11.Total 12.Unit <br /> HM ��ne�pfdanyl) No Type Quanety WLW. 13.WaoCoda <br /> cz <br /> (AQUEOUS BRAKE CLEANER) 4f <br /> Ujall)2 NON—RMA HAZARD= WASTE <br /> (AGUEOUS PARTS WASHER SO <br /> LU�'X I)hf) Dm G Z 4 <br /> I '—go "1 <br /> 1 <br /> 3. <br /> 4. <br /> e 1ne 4.Spaclel Hat>dlk>g IMOI tiM Add"i4 M n <br /> e, ."� <br /> 72072666 CA37 201710 �SG: <br /> 24 HR EMERGENCY #1-840-468-1760 (SK I TFI) b Z-1 <br /> RUTH AS "AGENT-FOR" BY OEM TO RETAIN LICENSED SUR CARRIERS AS �IEf:E33AR7 <br /> 15. GENERA70W&0FFER0n CER n"TION.I hereby Mare ft the twonls of iter mnKuMt are fully amf ap WA*desplbed Am by the p oW mppin8 name,am are r9as nw.pac(eyad, <br /> marked and labl4edtplammided,aware In au respem in proper ow~for h&w0d aemrdng to appGcahte k wmabmwend eeYonat gwommerltat ffl"tioms if expert strtpmant fim I am ft Pf9tsary <br /> Exporter,f carkfy ffia1 the wrxatNs of tiva mrtalgmten!tanfwm rD 1110 terms of the ti{t$dlad EI?4AdutoltdedgmeN dConsent <br /> I cm*stat the was1Y mtNrnizali0n staWnerg bvAed In 40 CFR 262-27(a)(e I am a large of n*ge or(h)(#I am a wW gemator)is hue, <br /> c-maly eGIV Omf tPdalad{Typed Signalum Da y <br /> u � III <br /> 1e.lnta shipmems <br /> t= ❑I"rort to U.S. ❑Ezporl tram U.S. Fort of exlt <br /> Trtlrtepar&x signature lror axpor'�rnYy}� Dale U.5 <br /> 17.TmffipuftAdmw$mkrna t of Paceipt of MWatlals <br /> Tye h1we SgnaEure moo Clay Year <br /> T= 1 "51 /1 1 <br /> '' SignatureMonth Day <br /> te.nl�apanry 671 7 <br /> 1 Ba.DimmVarxy Inftc 5pxe <br /> O.My ❑Type Residue ❑Pard Rejection ❑Fuw 32ejeoGpn <br /> Mmlifesr Rederwa Number: <br /> 18b.A 1w to Fad ty(nr Ga+terala) U.S.EPA ID Nwnber <br /> P_ <br /> W Factitys Phone; <br /> 18c,Signature ofAhmo Fao+blp(ar WqtgWj kAot>tlt Day Year <br /> LD <br /> go 18.Hawiv s Warta Repel NimpmonI140od Codas(i.e.,codes for hazeMaus*a*treatment dspasel,and mcydIrg sysiema) <br /> M t 11141 2. H141 3 a. <br /> II, �,:UesLgnetsd Fno�y Omw w OM*r-.Call mbm Of MWO d hazardous rnalsriaks ca+arad by the manifest ac*as nal ad in Item 18a <br /> emB NbiFV /!ear <br /> 1-7 <br /> aT D FACILrrYTO DIS44WION STATE(IF REOUJR€O) <br />