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Please print or .{Form designed for mCn elite(12-pitch}typewrtter.} o06363462sKsFarm Approved.(3M8 Nrr.2U50-(t038 <br /> UNIFORM FMA�ARDOUS t-Garsaramr 1i5 hr 2 Pag 1 of 3, r�p <br /> LCL'-9El�41]53 ` i[)l) 1 ! r0.s 4.EAatttfasiTrrolt' N'3'462 <br /> anbar *] Q�[ <br /> WASTE INANEFI ST 10063 4 6 2 SKS <br /> 5.General°ra Name std Ma�rsgl�ddress Generator's$;le Address(f dRarenl than ma ft ad s} <br /> al--Tr atrs • hofs Sly'- Lrn li <br /> STOCKTON CA ?5206 <br /> Gneatar'sphDri : 209t�....33a 6?33 CA 16240. 3i* <br /> �� 3 Ystm INC U.S.EPAI17Numbar <br /> 7.Transporter 2 Company Name U.S.EPA i1)Numher <br /> 8.DasgnaladFaralityFfanteand SileAoi sSAFETY—KLEEN SYS,Fw—', ijai.• U.S.EPA 10Numher <br /> 6000 SBTH STREFT <br /> SACRAMENTOS:F, 9�H;?3 <br /> 916-386-4913 r�1k)0001 X49:"3 r <br /> FarS;�ty's r hens: <br /> 9a. 91).U.S.DOToOsrafptioo pndLA14 proper Shipping Name,Hazard Class.i0 Number 10CCntaln�s <br /> H}A and Parkktg Gro .up Id any)) 11.Total 12.Unit 13.Waste Codes <br /> No. Type Quantity M Nd. <br /> 1 PON-RSCRA ('ift.Z..t3faPOUS WA Tt' y_IOUTL) <br /> (AQUEOUS PRAkE: CLEANER!' i <br /> a 2.fdElN--RGRA HAE§RE3IOUS (BASTE, <br /> (AQUEOUS PARTS WASHER GOL.MNIi <br /> 3. <br /> a. <br /> 77 <br /> 4.SPacal Handing instructions and Addwww I�oumatnon <br /> TSD'. SCA .0143 CSG 23 <br /> 24 SIF( EhER(3ENCY 01-800-466-1-x60 (S(4 r�I : � 191F-48SARI�q�ATH AS "ADENT—FOR" BY GEN T(] RETAIN LICEN'SC_fr `.i+EP. (AF `IE�;s CS <br /> 15 <br /> GENEnwked and lac lt7FFEROR S CEkTIfICATt4N:Thereby dean that tN Coot"of this cvnsdg—ent are�'and 8=rawy descrilled AUwa by ate proper shipping naru,and era dassllied,Packaged <br /> marked and Isht 1pfaprded,and are In ail respects in proper eond'Um fortransport a0wrding to appkWa a famatiwW and t hxwl 9rnmmnar1W regWalim,II ex *hpnt and I am trie Ftk m <br /> Expry <br /> orter,l ear*that the conleMN of this connignm"t can(Grm 10 Me terms o1 the eeadvd SPAM nowledgrivol of CanswL <br /> I cestiiy that the waste minimiWw statVment idandfW do 40 CFO 2GUI(al(e I am a large giwVdly generator)Of(b1(d I silt a small qw n*gerterafar)is true- <br /> Gene s Typed!!gilts Sgnat A1lonit rDay year <br /> 1 1&Imarrational kpmen <br /> ❑Itfq oot to U.S. [ Export from U.S. Pon antrylaxit �__ <br /> Trdr�Porter syy store Ifor pxporir;only): Date Waving U.S.: --- — - - — --T.Transposer AdmoMadWngot of Reo*0 Materia" <br /> T t PrntedT Name Signature haaoth Day —Year <br /> � 4 Q !7 <br /> Trans art n dName Sigrature hfanC+ pay year <br /> to.oancy <br /> 18a D,saepaecy Indication Spam L7 (]vant:y <br /> Type ❑Residue ❑PamaE Re{ectan ❑Fuif Re;adcn <br /> 186.AtsmateFadlP (or Generalml i�tanffesrReferendaNumber: <br /> U.S.EPA 10 Nsrmber <br /> LL. Facib/s Phone: <br /> p <br /> LLF 189:Signature of Aftemate FacNty for Generators ordh Drry Year <br /> Q <br /> z <br /> 19.Flarardetas Wasle Reptal Management hdeftc!Codes i.e..Codas for hazardom waste bwiriwfa de5posal,Ltd rMding sAlam91 <br /> LLI� t ;l9.4? 2. i•It 4? 3• 9. <br /> l <br /> Des4rtala3 FaCv t y Or*srs of Clperilor.Certitcatton qt reoai of ha uddous materials Covered by sm manifest except as noted in Item 1 so <br /> . <br /> AnWlrypo Name ��� � � � Day Year <br /> r ri Da y <br /> g ya3 2 / <br /> EDAFrtr�tt3tfi'I ]; e601 F zl l DIwSlC �11 CILITYTO DESTI ATtt3 STATE(1F REQUIRED) <br />