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SSL SK SHIP# 229845801 11111111111111111111111111111111111111 <br /> 0 0 7 3 5 4 7 2 4 S K 5 <br /> Please print or type. Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number CAR000039370 2.Pagf 1 of 31Err�rw,y k efP o$eo 4.Manifest Tracking Number <br /> WASTE MANIFEST -1007354724 SKS <br /> 5.eneratorName d Mailing Addres� Generator's Site Address(if different than mailing address) <br /> sci aon Premier rands Inc. <br /> 1905 Mchenry Ave <br /> ESCALON CA 95320-0000 <br /> Generators Phone: 209-552--6051 <br /> 6.ftfrtTVcoffla�ytffeSYSTEMS INC U.S.EPA ID Number TXROOOOS120S <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 10001, <br /> 8.Designated Facility Name and Site Address FEMS, INC. U.S.EPA ID Number <br /> 6000 88TH STREET <br /> SACRAMENTO CA 95828 <br /> 916-386-4913 CA0000084517 <br /> Facility's Phone: <br /> 9a 91b.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)) No. Type Quantity Wt.Nol. 13.Waste Codes <br /> G 134 <br /> 0 1 (AQUEOUS PARTS WASHER SOLUTION) k <br /> W <br /> 0 <br /> W 2. <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional Information a c 201947 21 <br /> l v � �O <br /> 24H EMERGENCY#800--468-1760-CH/SK/TFI-Contract retained by gener� V <br /> tor confers agqency authorix <br /> on initial transporter to add or substitute additional transporters on genera. or's behalf. <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(b)(if I am a small quantity ge erator)is true. <br /> Generator' eror's Printe/Typed Name Signat Month Day Year <br /> At <br /> J 16.International Shipments <br /> F— ❑Import to U.S. ❑Export from U.S. Port of entry/exit: <br /> Z Transporter signature(for exports only): Date leaving U.S.: <br /> W 17.Transporter Acknowledgment of Receipt of Materials <br /> LLI <br /> a Tr ( Pry^ed Na ' Signature Month Day Year <br /> 1 e-. <br /> CO) Transport 2 Printed/Typed Name gnature , i Month Day Year <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space <br /> Quantity El Type El Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> LL Facility's Phone: <br /> Q <br /> 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> Q <br /> Z <br /> y19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> LU <br /> 0 1. H141 2. <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> ince ed Name Sig re o Day Year <br /> TJ YA A <br /> E F r v 7 Previous e i ions are olete. <br /> �� � � 0 I ESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM <br />