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SSL 514 SHIP# 28794996 1111111111111111111111111111 <br /> 0 0 7 0 9 0 8 4 0 S K 8 <br /> PleaseTint or <br /> P type. Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number CAR000039370 2.Page 1 of 31Emgfg U, gspo0se phpReO 4.Manifest Tracking Number <br /> WASTE MANIFEST 1 UU JJ VV 46ii 1(6 007090840 SKS <br /> 5.Ganemees;Name and Mailing Address Generator's Sil Address(if dillerent than mailing address) <br /> Escalon Premier Brands Inc. <br /> 1905 Mchenry Ave <br /> ESCALDN CA 95320-0000 <br /> Generator's Phone: 209-552--6051 <br /> s.T§WMP-0Rt1N8SYSTEMS .INC U.S.EPA ID Number } <br /> TXk000081:.05 <br /> 7.Transporter 2 Company NameA U.S.EPA ID N be <br /> L <br /> 8.Designated Facility Name and Site Address SAFETY-KLEEN SYSTEMS, INC. U.S.EPA Iff ber <br /> 6000 88TH STREET <br /> SACRAMENTO CA 95828 <br /> 916-386-4913 CA000v08ri517 <br /> FacYiy's Phone: <br /> 9a, 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, .Containers 11.Total 12.Unit 13.Waste Codes <br /> HM and Padang Group(it any)) o. Type Quantity Wt.Nol. <br /> I NON-RCRA HAZARDOUS WASTE, LIQUID G 134 <br /> o (AQUEOUS PARTS WASHER SOLUTION) p � <br /> z 2. <br /> W <br /> C7 <br /> 3. <br /> 4. <br /> 14. 'IHaMIthglnstructionsandAdditionallnfonnation TSD: SCA 80404118 E612014 201,929 C !sagncy <br /> I <br /> 24H EMERGENCYM800--468-1760—CH/SK/TFI—Contract retained by generat/t:or con-le- a+tLhori y <br /> on initial transporter to add or substitute additional transporters on en r r ` <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 Iabetedlplacarded,and are in all respects in proper condition for transport according to applicable intematio I and national governmental regulations.If export shipment and I am he Primary <br /> Exporter,I certify that the contents of this consignment cordons to the terms of the attached EPA Acknowledgment of Cont. <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)if I am a large quantity generator)or(b)(if, m a small quantity genemtor)is true. <br /> GerimatorslOfieror's Pdntedyfy _ Signalu Month Day Year <br /> ` <br /> l� 1G1 � Z Q1 1 <br /> 16.International Shipments <br /> Import to U.S. ❑Export from U.S. Port of entrylexit: <br /> ? Tramporter signature(for exports only): ate leaving U.S.: <br /> W 17.TmnsporterAdmowfedgment of Receipt of Materials <br /> The r 1 Printedrryped me �" Si Mon Day Year <br /> 16-) 119119 <br /> Q Transporter 2 Printed/77 <br /> rinted Name Signature Month Day Year <br /> t— ? Z3 1 <br /> ♦ 18.Discrepancy ' <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Rai We ❑Partial Rejection ❑Full Rejection <br /> Manifest I eference Number: <br /> 18b.Zennate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U iLL Faciliys Phone' <br /> w 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> a <br /> z <br /> h19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 1' N141 2. 3. 4. <br /> 1 20.Designated Facilityer or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> PrintedrTyped Na Signature Month Day Year <br /> 17 1311 <br /> EPAF�rI�1B700-�72�6012-17) Previous editions are obsolete. DESIGNATED FA IT T EPA's e-MANIFEST SYSTEM <br /> 1) Y41 1 23 <br />