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SSL SK SHIP#R 23463639-7 11111111111111111111111111111111111111 <br /> 0 0 8 2 3 1 1 3 8 S K S <br /> Please print or type. Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number Ci`-AR000039370 2 Pae 1 of .f3.,E nc�2e ons��ho�e 4.Manifest Tracking Number <br /> WASTE MANIFEST r 1008231138 SKS <br /> 5. enerats Name nd Mailiog Addr Generators Site Address(if different than mailing address) <br /> sca° On k�remierranefs Inc. <br /> 1905 Mchenry Ave <br /> ESCALON CA 9530-0000 <br /> Generator's Phone: <br /> n i?� U.S.EPA ID Number T. R,1 i •8 i� r Fi;y-e <br /> 7.Transpo 2 Company Name I U.S.EPA ID Number <br /> a <br /> f 0-3 s-3 Z z 2-1v <br /> 8.Designated Facility Name and Site Address Y i FN SYSTEMS, INC. U.S.EPA ID Number <br /> 6000 SETH STREET <br /> SACRAMENTO CA 95828 <br /> 916-386-4913 <br /> Facility's Phone: <br /> ga 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes <br /> and Packing Group(if any)) <br /> HM No. TypN Quantity Wt.Nol. <br /> G 134 <br /> o <br /> (AQUEOUS FARTS WASHER SOLUTION) <br /> w <br /> Z 2. <br /> W <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional Information S 1 2 14 202133 CSG: 21 <br /> 0 <br /> 24H EME:.RGENC;Y4#800--x4"8•-1760•-CH/SK/TFT.-Contract retained by generator crrlfel,E; agency iii,it;�'Or ! 2, <br /> on initial �t:r�anspor• ter to .add or substitt.0,- additional. trlansporte�rs on genera oris k;eh;;p <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 the attached EPA Acknowledgment of Consent. <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or (if I am a small quantity enerator)is true. <br /> Ve erator's/Offeror's Printed/Typed Name XUr- Month Day Year <br /> Tv kA IJ 2 e P 1 21 <br /> 19, rnational Shipments <br /> ❑Import to U. ❑Export from U.S. Port of entry/exit: <br /> ? Transporter signature(for exports only): Date leaving U.S.: <br /> CZ <br /> 17.Transporter Acknowle gment of Receipt of Materials <br /> I.- nsporter 1 Printe yp Name ra7turOCMonth D Year <br /> O <br /> IL <br /> 1. <br /> Z� 10 <br /> Transporter 2 Pnnted ped Name ign ure Month Day Year <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑ ❑Partial Rejection ❑Full Rejection <br /> Type Residue <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> Facility's Phone: <br /> w 18c.Signature of Alternate Facility(or Generator) <br /> Month Day Year <br /> Q <br /> Z <br /> N19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 0 1 H141 2. 3. a. <br /> 20 Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> P' y Name \ Si ature Mon h [ay Year <br /> A f 0 9 ^d-►l <br /> 17) ervious editions are o SIGNACILITY e-MANIFEST SYSTEM <br />