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$K SHIF-4 22:58ESOS 111111111111 <br /> p06363462SK3 <br /> Please pont or type.(Form des iiec form on alto 02'piteh)typewriter.) form prayed-OMB Na.2050-0039 <br /> r 4.Martif�t Tractd Number' <br /> t.Gettestttor tD 1 brmber 2.Page,d. 3.�t oy R e�gge 0 6" 3 4 6 SKS <br /> UNIFCrRMHA2ARp0US rtii~�:s9Cir.'4�3535� ,3. <br /> WASTE MANIFEST <br /> 5.Gu*rry� rarss <br /> Wss Name and Moling Addre{{/ Gemrarors SAsAddress�d4 onmt then ma�rrg aftws) <br /> Cal-- any Shop 10- L xAl C—il .shoji {i 0... Lodi <br /> 1603 S P St 8.44a E F'2?r t2 5 <br /> 9TOCK'TRN CA x5206 <br /> CerwratoI,SpW,s: 209-333—6953 Cr0 :A 95.40- .3j,1H <br /> D. U. . PR IO Ntanber <br /> I��.�lbr SYS"CEf3S :LNC <br /> 7.Transporter 2 Camp"Name U.S.EPA M Number <br /> 8-Dewe atedFaMyNameandSiio SAFETY—XLi^EN '; Ehfr <br /> .i 4i. U.S.EPA ID Number <br /> 6000 SETH ;TREE'? <br /> 5�`t�RAi�EMl)3 i: a �1ri�`` <br /> Faaa 's;�trone: <br /> pa, 9b.U.S.IyOTDascripGan lrndu44 g Proper Sr apng Name,Hazard bass.fD Number. ,d,CrxttaineM i 1.Total 12.UM ]3.Wade Codes <br /> HP and P"Group(if any)) NNlat <br /> o. Type Ouanbty %gt , <br /> 1. NON—RCRA I-IAZFtNIMS WASTE L.TQUTC. � ?F � (ll 134 y <br /> IX (AQUEOUS BRAKE CLEANED: <br /> a z.hfi]N—RCii INAZ�tRDCttlS WASTE, LIQUID <br /> Lu (AQUEOUS PARTS WASHER SOLUTION) <br /> 3, <br /> 4. <br /> i <br /> i <br /> d.Specal HandFng lnswctimreVdA&WMI sarnacn TS 0: 15CA 7 9 d6 r.3_':_ ;^'".'fro =()S 743 C56 `3 <br /> 4 HR EhERGENCY #1-800-468-1760 (5K i'Fl <br /> ALITH res "AGENT-FOR" BY Data TO RETRIN LICENSED jiUR CARRIERS AS <br /> M GENERATOR'SIOFFEROWS CERTIFICATION:I hereby de6am that Die rant nts of Na rmggranerd are fu9y and a=rateiy descfibed above by the pry ung name,and are duWfisd,patfta* <br /> marked and labelWplacarded,and ars In all respeefs in proper mndlm for kwwart scowft to appivibie ademabonal and nalIMM garatnmeniai regufalions.d eypart hpm!mt and I am the Primary <br /> Exporter.i certify thal the contents of this mnsignu"I Maden to the terms of the abadw EPAAOnaMedgmear of Consent. <br /> E�h'that dne wa&'.e rzkromiistien stalemant idealif�d m efl CFR 282.27(a)(a I�r a large quarHily germrator]ar(bJ(dl am a sma8 quantify geoerata)is tnre. <br /> dil <br /> Genera6olsl yped Nam 3 grsa Month Day Year <br /> 16.fnlamaW W Shipm t <br /> i- ❑Imgart to US 1 .E"a from U.S. Pdna Uyiexif: <br /> Z Trarnportor signature(tor exports eniy): _—..- <br /> � i7.Tran5p071p•Ac�tadgmenttlfR�ai<ttoiAlatEr�'S <br /> h er 1 Primad(F Name Signalurs Mone, Day' Y'M <br /> $ emsq <br /> a a 5 11-7 <br /> ire r2 Noma Slgaahrse Month Day Year <br /> © ZZ l Z <br /> ,a.vlrrrepaney <br /> 18a Dismparxy Ind talion Space ❑ Qwntity ❑Type ❑Rasidse ❑Partial Rejeeban ❑F.4 Region <br /> MarwiRst Reference Number: <br /> tab.Altemale Faci4 ry(or Generalorf U.S.EPA 0 Ntknber <br /> Faairys Phone: <br /> 1F Signature OfAaiiwaw FRAty(or cwtarator) Monttr Day Fear <br /> 4 <br /> z <br /> tB.Hazardous Waste Report Management Nk trrod Codas tie-,codas fpr hatardaua waste treatment d spore#,and recyClbrg wetemsy <br /> HI-41 3� 4. <br /> Designated Farcy O+a�or Operator.Cer6cabon at oR halardous materiels covered by the manitaw aimpt as mled' <br /> � .�n� ypslNarrte I D11 �1��7/ Signa <br /> �� Item 18a <br /> L th Z2- <br /> 1 /71 <br /> EPA Frm gg 00 22{ a.3 P v u <br /> � - I)E51�NA D EACILITYTO t~1ES['1 ATt(9 NATE{if REQUIRED) <br />