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SSL K tHIPO 2315_7987 <br /> . f <br /> Please print or type. Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2..Page 1 of .Emp rr Psponse Phone 4.Manifest Tracking Number <br /> � -�����_...., SKS <br /> WASTE MANIFEST �A- � a <br /> 5.Generators Name and Mailing Address Generator's Site Address(if different than mailing address) <br /> _scalon F reit ier i;ra,d�- nc, <br /> 1905 Mchenry qvE , <br /> ESCALON CA 95320-0000 <br /> Generator's Phone: <br /> ?09-L.1`-605i <br /> 6.T�raspter,tC9rIWaCe�1StEr15 1�)w U.S.EPA ID Number �Y.F;VaOt;' <br /> 7.Transporter 2 Company Name '//] U.S.EPA ID Number <br /> 8,Designated Facility Name and Site Address SAF Y—<LEEH SYSTEMS; TNC. S.EPA 10Numbbr <br /> 6000 8Eiy STREET <br /> SACRAMENTO CA 95828 <br /> 910-386-4913 CAG000084517 <br /> Facility's Phone: <br /> ga, 9b.U.S.DOT Desc3rip8on(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers It.Total 12.Unit 13.Waste Codes <br /> HM and Packing Group(it any)) Na Type Quantity WLNol, <br /> 1-NON-RCRA HAZ^r(,DU t!ASTE, L OUIC <br /> 0 4AGUEDUS FARTS WASHER SOLUTION) <br /> z 2. <br /> LU <br /> 3. <br /> qu <br /> 714.Special Handling InsWctions andAdditiona nnation L7' R =J649224 ;120'_4 21.122030 CSG 21 <br /> 24H EMERGENC`!0800--468--1760--CH/SY,/TF1-CQntraft retained by QRneratar confersa ef'Cd .,ut ari4 <br /> on initial tr ansoarter to add or subs•�itute additional trans)of—dear's an I?nf`roVir ' , '7 '�t•r f. <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION:I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, <br /> marked and labeled/placarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations.If export shipment and I am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terms of ft attached EPAAcknowledgment of Consent. <br /> I certify that the waste minimization statement identified in 40 CFR 262:27(9)(d I am a large quantity generator)or(b)(d I am a small quantity generator)is true. <br /> Generators/Offerors Pdntedlfyped Name Signature Month Day Year <br /> �uP fes-' <br /> 16.International Shipments Q import to U.S. ❑Export from U.S. Port of entryletdt <br /> i— <br /> Transporter signature(for exports only): Data leaving U.S.: <br /> w 17.TranspoderAdmowledgmenl of Receipt of Materials <br /> 17 Transporter 1 PrintedlTyped e Month Day Year <br /> a �7f C�an.�c1,•. "�V%� 7 a <br /> z Transpo dntedffypsd Name �+ Month Day Year +. <br /> 8.Discrepancy <br /> 1 Ba.Discrepancy.Indication Space . El Quantity ❑Type ❑Residue ❑Partial RejectionFull Rejection <br /> ❑ action <br /> Mandest Reference Number. <br /> 1 Bb.Alternate Facility(or Generator) U.S.EPA ID Number <br /> U <br /> Facility's Phone: <br /> 18c.Signature ofAlternate Facility(or Generelor) Month Day Year <br /> Q <br /> Z <br /> 19.Hazardous Waste Report Management Method Codes(I,e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> t 2. 3. 4. <br /> 20.Designated Facility Owner or Operator.Certification of receipt of hazardous materials covered by the manifest except as nded In Item 189 <br /> 747ed,Name 1 Sipa Month Day Year <br /> 9 ( 7 a . I t �.�_ ]p Y1 n _d {d, r. <br /> EpAF10 8700-22,(Re 17) Previous edillons areobsol e. DESIGNATED FACILITYTO GENERATOR <br />