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SSL SK SNIP*.228235470 , <br /> Please print.or type• Form Approved.,OMB No.2050-0039 <br /> UNJFORlA HAZARDt7U8 1.Generate ID Number 2.P!I—Fff <br /> P��p 4.Manifest Tracking Number A SKS WASTE MANIFEST CA R0 39370 1!� O0704O343 VKV�Generatnrs Name and Mang Address 'Generator's Sita]1d {d dRerent than mailing address) <br /> EScalon Premier Brands Inc. <br /> 191 rmhenry Ave 'AESCALDN <br /> Ger erators t>ta: 219-558-6051 \ <br /> T SYSTEMS INC � �� U.S.EPA Ib Number SYSTEMS <br /> 7.Transporter 2 Company Name 'y r' . U.S.EPA ID Number f <br /> MAI)@3932�� <br /> .GLEAN HARBQRS-ENVIRONMENTAL SYC INC. <br /> 8.DesigQpated Facility Name and Site Address SAFETY-KLEEM SYSTEMS; INC. U.S.EPA ID Number <br /> SACRAMENTOSTREET s CA 95826 <br /> s 916-385-4313 CA00@W84517 <br /> U.S.DOT Description(ihdtrdmg Proper Shipping Kant,Hazard Class,ID Number, 10.Containers fl.Total 12.Unit 13.Waste Codes <br /> HM and Paddng GYoup(dam))-- No. Type Quantity Wt-Nd. <br /> 1 NON-RCRA HAZARDOUS WASTE LIQUID DM S 134 <br /> o (nmE0U5 PARTS W swi SDLUT 15N) <br /> 2. <br /> t <br /> a. t3y <br /> ' x <br /> Special Handling Instructions and Additional Information TSD t CA 7yF3414 0 E$1201 4 <br /> 24H EMERB"CY#800-468-1760-CH/SY./TFI-Contract retained by generator confers agency author:, y <br /> on initials—transporter to add or substitute additional trans orster on generator's behalf. <br /> 15GENERATOR'SIOEFEROtIPS CERTIFICATION:I hereby declare that the contents of this consignment are fully and accurately descnbed above bylhe proper shipping name,and are classlfieQ packaged, ' <br /> marked and labe}edlp cgM#d,and are in aV respects m Proper condition for transport according to applicable irnemational and national govemmental regulations.If export shipment and f am the-Primary <br /> Exporter,I certify that thgmntents of M consignment conform to the terms of the attached EPA Acknowledgment of Consent <br /> ?>t certify that the waste minim6tion atatenlent Identified in AQ CFR 262.27(a)(A[am a Large quantity generator)or[b){di ams Waliquantity generator)Is true, <br /> Gene ata <br /> If roe Pnnfed/Typpd N Siga ptuI Month Day . Year <br /> ..c r. .S.- nv moi„ :p �Vq,�l�@, ```•; "�i ` <br /> Sl�I I• -Fa A.- `.1• I'''`�ry� 1 ate' .ti. ._ <br /> )a in)errhailonal �fIpIrl8rlt3 , Q Impo(tt0 U.$. „ QFxporl fm U$ af,erdrylexrt; as <br /> . � 'rsignaluld(for:exD4fth9[Ifyl: DaleieavinglTS r i. <br /> W,.1i T, p4rler Acknowledgment of 77 "". <br /> F 'Tra prfei1'E edl{ Month DDay, Y.Part. <br /> - U3. 7 PTYP�N�- � �Month Day 7 Year. <br /> �S.Discre <br /> �,piecfepancy Iddicatlon'Spaca -^ Q�aty OType ©Residue 'O FuII.Rejechon <br /> Manifest Reference Number <br /> • ?8b:Altemate'FadYdY(orQeiieratoT)'- +,., r ,v..i.. _, •l ... ': _:•- a.>; :::r&tr+.,c�; f Er6PJ>TIB Numbers <br /> LIC. Facility's Phone', <br /> W 18c.Signature of AMemate Fadlity(or Generator) Month !1 Day Year <br /> 9.Ha*dWs,WastsReport Management Method: des 0.e.,codes fol hazardous Waste lraaI disposal,and recycling systems) <br /> cl; <br /> 14141 <br /> r <br /> 20.Desigristgd Fsoplty. Operslor Cert!teflon o(recelpt•gf hazardpue'materlgh coveted by thd gtanit%s 6>f 'pl qs no(ee In.Item 1Sq. . <br /> Ne�1ra,> a .:Y;r ,..:•'' g•.cw :�,•, �F 31gn on(fla Day dear <br /> P <br /> EFn S QO 2 reVlpui;0ditlons aroobsoldte. F DESIGNATED FACILITY 70 GENERAT R <br />