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SSI: <br /> SV.SHIPO 231492663 <br /> i <br /> Pleasf print or type.. . _ i Form Approved.OMB No.2050-0039 . <br /> UMi ORM HAZq)jb[bS' 1.Generator ID Number r 2 Pa d-of 3 EJn R pp ne 4.ManifestTracktng Number <br /> WASTE MANIFeST. CAS�O0�i'6 i� 7'6. �. 1��� 1�bt} � S1�a7 <br /> nn7 F; a IT-7 <br /> i` 5 Generators Name and MallingAddtaSs Generatoes Site,ditess(if different than mailing address) <br /> FG: calor R •�mter iIrMids- Inc <br /> -M5 Ilchei ry Avg' <br /> E'SCALON CA Ti.SR20 <br /> GerieratorsPhone: C — �G•'6Q <br /> ns o CO U.S.EPA ID Number_ <br /> PrP �f�r— Ys�:a; s INC <br /> 7.Traesporter 2 CahpanyName ' U.S.EPA ID Number <br /> a.Designated Facility Name and SlleAddress- U.S.FPA ID Number <br /> a, •. .,. 5`PkC►�H(LEEN '5*-STtM!�-;,-YNC,..• - <br /> `bpg0 86TH STREET <br /> _ SACRAHENTO CA- 95826-- l <br /> 9i: r^W6-49 2- Ca(lof fit{btui <br /> ha'c lity's Phone <br /> ga. 9b.U.S.DOT Descdpdon(including Proper%jppl Name,Hazard Class,ID Number, 10:Cwtalmrs 11,Total 12.Unit. 13,•Y�yste Codes <br /> 1 Hµ' and Paddng Group(any)): No Type Quantity WfJlfaf. <br /> 1. NON-FtCRRA: W474RDOUS VAST-E, LIQUIFY: � u . 134 <br /> (AQUEOUS PARTO WASHER SOLUTION) <br /> :! ( DM <br /> LU <br /> z' . <br /> ..•� asci. . . - : . • _.. ... <br /> #: 3 <br /> -- _tic.' - " ..' •_ � i� <br /> _ - R• - <br /> %T N .. Y <br /> '47 pedal Handling Instructions and Additional 1pforrnatlon T6:SCA 8 28 O tS12414 2��0yy2��024 CW:21 <br /> �41i EHEkG1=HCY#800-•�t611 �:Tfd-CNISK�TFI-Contract reta)6 .by gQneraf.a� con i a. envy. air�harZ <br /> injj1.; ,;, .:,r,rli't: �'i_' i A n �. .: 's. his s7-R <br /> 95: GEN ERATCR'SIOFFEROR'S CERTIFICATION:)hereby declare that the contents,61%s mrrlfgnment are fully and aca ralely described above by the proper shipp ng name,and are classified,packaged. <br /> Z marked and labeledlplaprdetl,end era in all respells N proper corldiBon for traF sport acobrddigao applicable latemabonal and national governmental regulations;If export sfiipment and I are the Pril <br /> Fxporte,l.certify that the contents of this_colrsignmenttform to the lama of the edaol>ed L PAAdmavtpdgtrrent of Consertt ' <br /> F I cerby that the yv s -rtinimdation statement ldenttfied In 4g CFR 28227(a)(d lama targe quantity generator)or(b)Q11 am a smau,quantity generator)Is true. <br /> �enerator s/Oflerars Pn yped Name _ Sig / 4: MonSh.- Day Year <br /> Af <br /> cJ -1 In mapon8l Shlpmegla. - <br /> Fr: : LJ Impopq 115:.:• �Fgiprl,from U.S. Part d errlrylexit <br /> r�Transportel slgnahrre(Idrexpbrts onty) Date leaving U.S.: <br /> � ftjIdnspoiterAckrxWeUgmeni•ofReceipt o(tgisleiielS <br /> T porter LIU <br /> 1 nn-d Name Mono' `Day Ypear <br /> 1- 2 7ranSporter• Prinled/Typed NAme <br /> Month' Day Year_ <br /> 110 <br /> e J <br /> 8:D15crepanay - <br /> 18a,Discrepancy IndicationSpace, :. .Quandt#. ❑Type_ ❑Residue. ❑Partial Rejeciibn. Fu0 Rejection <br /> rg <br /> M4 t 1�r MapHest Reference Numb: <br /> 1 Bb Alternate Facility(6r Generalor)' . -.d U.S.EPA ID Number <br /> R'. MM <br /> 20 <br /> 1W FiOV&Ohone.' <br /> LU 18c Signature ofWtemate Fadbty(Or-Ge r) , Month. pay Year <br /> ._ � �'-;•• '•.',•: '.••. •til :�..•.•.� . :•. _ , <br /> 19;Hetardoug Waste Report Managemelreatmenkdlsposal,end reLyding systema) <br /> 2 -T7\ <br /> 20:dgsignaled Fac4 <br /> t Owher Or Opetafor Certibcaupnof redetplof hazardous mate �ered boby the manliest except pe nded th Item 18a <br /> Prin ame nature )cion Day Y* ; <br /> EP�l.F rrp8700-22(Re - ) fevops ,I ons:ateobsol. e. DESIGNATED FACIL)TY,TOGENERATOR <br /> Z;) 4941/156023' <br />