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FIs'## cJ3 .9 4�O II�I�I�'II�I��II��I�I�IIIIII�II�IIIII <br /> 0 0 7 7 3 2 8 8 4 S K S <br /> Please print or type. Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number (-AR ]000393:,r(4 2.Page 1 of 3;Enmg"cy �ggQruelP �y 4.Manifest Tracking Number <br /> WASTE MANIFEST 007732884 SKS <br /> 5. enerato's Name d Mailiw Address Generator's Site Address(if different than mailing address) <br /> i.t os .I'I•ghenrt3 Ave <br /> FSCALOM CA 99320-0000 <br /> Generator's Phone: 209-S52-'•60S1 <br /> 6.Tl tt r.1'rp�tp�y�l�tr,eL,yS)"c IH( U.S.EPA ID Number q_ <br /> T X R 0 0 0 0 81.;.' <br /> 7.Transporter 2 Company N U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address a - ,_t:•. s '6 1 L M L, U.S.EPA ID Number <br /> 6000 98TH STREET <br /> SACRAMENTO CA 9EB28 <br /> Facility's Phone: <br /> 9a 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit <br /> HM and Packing Group(if any)) 13.Waste Codes <br /> No. Type Quantity Wt.Nol. <br /> 1 (AQUEOUS c,AI�T£{ WASHER aSOLUT I ON J /0 VA <br /> w <br /> z 2. <br /> LU <br /> c7 <br /> 3. <br /> 4. <br /> E <br /> 14.Special Handling Instructions and Additional Information I S 1) S L, •. V+ r_ :.:r.,.1,".1 ,. �.t,1i T I L,b tj t <br /> :.�H FNl:R.f3ENC' ##800--468 -1760-CFi/SkiTFI;...Contract retained bq gen,rat,,:,t~ confers �a 'rtty <br /> On ini ial tF,anspc,t�ter 'cry add al' stJl Sti�tkitE, Additional <br /> transporters on genera�of s Iix:shia.�• <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;4)(if I am a small quantity generator)is true. <br /> Generator's/Offeror's Printed/Typed YameSignature Month Day Year <br /> C <br /> 16.International Shipments <br /> F ❑Import to U.S. El Export from U.S. Port of entry/exit: <br /> ? Transporter signature(for exports only): Date leaving U.S.: <br /> W 17.Transporter Acknowledgment of Receipt of Materials <br /> LLI <br /> Tran�OrtM1PintedTyp Nae Signature Month Day Year <br /> Ix <br /> O '{\j <br /> IL <br /> au ��ew�, C�, <br /> Z Transport 2 Printed/Typed Name _ Signature Monfh Day Year <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> F 181b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> LL Facility's Phone: <br /> In 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 /> LU 1 ;.t14t 2. 3. 4. <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' ame S' ature Month [may Ye <br /> EPA f*gr Q0;2 y�� 1 Previous editions are obsole SIGNATED FACILITY TO PA's e-MANIFEST SYSTEM <br />