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SSL �iK SHIP#4 233548602 IIIIIII IIIIIIII III 007912818 SKS Please print or type. Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1 1.Generator ID Number CAttQ(itC+393 � 2.Pa!e 1 of 3 Erp cgyttcy Rgs nse P�n 4.Manifest Tracking Number -rf ] 1}t] 1 1007912818WASTE MANIFEST SKS 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) E'5calsfn Premier firands Inc. 1905 Mchenry Ave £SCALGN CA 95320-0000 Generator's Phone: `O9—SS` -6051 6.9iAepertY.0 fttfWeSYSTEMS INC U.S.EPA ID Number TXROOOOS1205 7.Transporter 2 Company Name U.S.EPA ID Number CLIA- M XPo373Z�Z�0 8.Designated Facility Name and Site Address SAFETY-VLEEN SYSTEMSINC_ U.S.EPA ID Number 6000 88TH STREET A4 SACRAMENTO ._ 9'-•S828 916-386- 4913 CA0000084SI7 Facility's Phone: ga 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit HM and Packing Group(if any)) 13.Waste Codes No. Type Quantity Wt.A/ol. 1.NON.-RCRA HAZARDOUS WASTE, LIQUID AG 134 0 (AQUEOUS PARTS WASHER SOLUTION) � �(0 e rg, 1 0 z 2. W 3. 4. 14.Special Handling Instructions and Additional Information [ 8548Y484 ES12014 202110 CSG:21 2` looggt--n,\_Q_$ a 24HEMERGENCYN800•-468-I760-CH/SW/TFI-Contract retained by generator confers a l au•t.hor:i•t cin initial -transporter to add or substitute additional trans transporters on enera�or 's behalf. 15. GEN ERATOR'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, 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 Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a small quantity generator)is true. Generator's/Offeror's Printed/Typed Name Signatur Month Day Year SUAN IZ o� 03 0� a J 16.International Shipments F ❑Import to U.S. ❑Export from U.S. U Port of entry/exit: ? Transporter signature(for exports only): Date leaving U.S.: W 17.Transporter Acknowledgment of Receipt of Materials LU Tr porter 1 Printed/Typed me Sig natu Month Day Year a0 r�M �.v Cn.►f C> 0l3 Ja 1 Z Tran orter 2 Printed/Typed Na ature Month Day Year � > 6 3 7/ 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type Residue ❑Partial Rejection 1:1Full Rejection ❑ Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number J U LL Facility's Phone: La 18c.Signature of Alternate Facility(or Generator) Month Day Year a z N19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 0 1' -4141 2 3. 4. 20.Designated Facility Owner or Operator:Certificatioa of receipt of hazardous materials covered by the manifest except as noted in Item 18a P Typ ame ig 1 M nth Da Y .1 iy-u 10 1 1 ZJJ pJ71 '';`P941J17) Previous editions are obs e 401( AD C EST 9YSTEM