Laserfiche WebLink
SSL Sk SHIP4 224312537 mer <br /> • 11111111tt o � 5 � Bill <br /> Please print or ' n <br /> pe.(Farm desed for use on elite(12-Pitch) 4 S K 8 <br /> Form OMB No,.205t1-N39 <br /> UNIFORM!MANIFEST IS 1.G 0 U NWe CAD?8241:usl 2 pair 1 of 3.Elpgjq�y — 4,than tTracWrQ Nw*w <br /> w,STM„I,f,�sT 1 �fult-' 5 SKS <br /> Gene2lofa Name and Ma ling Address Generator's S'4e Address(d ditem than maS1 ng address) <br /> Gal-Trans chop 14- <br /> Lodi Cal-Travis Shap 1.{1-- Llbdi <br /> 1643 S D St 845 E Ping St <br /> STOCKTON CA 95206 <br /> GensrralonPhane: 2G9-333-6953 !UDI CR `'Sc?�k ilr'FI <br /> 6.h rVftTteSYSTEnS INC U.S EPAIDNumber <br /> 7.Transyarter 2 Company Name <br /> U 5,EPA Ip Nutri ' <br /> 8.l�ignafimd Eerlity Name end;ite <br /> SAFETY4'KLEEN SYSTV19, F.. U.S.EPA 1U Number <br /> 6000 88TH STREET <br /> SACRAMENTO CA 95828 <br /> FadahJs imine; <br /> 4a. 9b.U,S.I�TTtJa9a,pkon{ir:cturtg Pmptr Stuppin8 Nome.Hazard Class,If)Number. 10.CoMa4rors 11.Tdral 12.lkoit <br /> HM Pad�rt9r3hwa{teny]) No. Type Quantity WtNot. 13.Waste Cotler <br /> 1. <br /> 2.117NACRA HAZARDOUS bC1E#S lar431f:, LIQUID a G 134 <br /> (AQUEOUS FARTS WASHER SOLUTION) <br /> E <br /> i <br /> 1 <br /> r i <br /> - 14. Haaainy tructgnsandAidttianallydontlatioo [}:S X6136" 1 C4370 '3 20183 CBG:2:3 <br /> 24 Hk E14EttGEidGY #1-800-468-1760 (SK >f Tl±I? <br /> I <br /> RUTH AS "AGENT-FORA BY GEN TO RETAIN LICENSED SUB CARRIEPS AS NECESSARY <br /> I5. GEMERATDR'S10FFEkfi'8CERTMGAWN; I rlerabydedana that ale mnteftofthis wnslgn nW are"end atx AMA described arias by riteMWslayp°.ng name.Ordare dasathad, <br /> markad and IaMlsdfplscsrded,and Amin al respects A Proper edition tar Can4W accord to appboave nSsala4p!Ialand naGanel aTy <br /> "� 9�,,a1 reetieas.IF axporf shilaCl!arri I am the PHmsry <br /> sxpartar,E CArtifyihal t}te carttrrds Of chis arxssagtunent Wntarm to the terms orcins al,actied EPAAdmpv+l8dgmenla!C®oaent. <br /> i certify that the xasta firmMMidentified N 40 GFR 252271a){d I am a large 9uailk geesratw)or(b)(dI am a smalt is uw. <br /> Month D Year <br /> Ga aratora ams 11 <br /> g�J <br /> — A, <br /> � t5.I'ztamaliartai Shipments <br /> A 19 <br /> to U.S. ❑Export trom U.5. Ponuf rattrylexie <br /> ' 7ra.rsperter x�>aU+re{!or exports only]: Data leaving U.S.: ---..�_-- <br /> W 17.TianspW.erAckrWWgman;of Reeeipl of Matesiats <br /> T Nerne r. <br /> u. <br /> e Z— <br /> ra:s p tuna Srglselure tha th Day Year <br /> T <br /> 18.Discrepancy <br /> 182.Dwepwvy Indication Space ❑ 4ian y ❑To. ❑Residue ❑Partici Rection ❑Full ReM=n <br /> Iclanifdst Reference Nwabec <br /> I Ob.AP&mata F2dl ty for Ganeratot) U.S EPA ID Ntldter <br /> 0 <br /> lt Fec'iv*phone: <br /> LLj 18c.SIgnsturontAttem le Fadlty(or Ganerator) Month Day Maar <br /> 19.Hazardous Wasto R&Xd Managemart Melhcd Codas(t.e.,oodea for h8zardous+xatbireat7wt,disposal,and regckV systems) <br /> 2. H141 3' 4. <br /> �t3,t]eaigna,ed fari5ty Ourcor a 4paratos:GarH{katian of recaipF of I�zenious rremrela mvered t1y the manifest exoapt as rated Item 18e <br /> XY <br /> D- <br /> EP F O 2 v& DESIGNATED FAMITYTO DESTi O STiATE(IF REQUIRED} <br />