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SSL SK SHIP# 231827987 (111111111111111111111111111111111111 0 0 7 6 8 4 8 9 6 S K S Please print or type. Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number CAR0000393702.Pae 1 of Er � �s�ns�R�$nA1007684896 4.Manifest Tracking Number SKS WASTE MANIFEST VV V„V 5.�ieneratos Namepnd Mailirtg Addregs Generator's Site Address(if different than mailing address) tsca on remier brands Inc. 1905 Mchenry Ave ESCALON CA 95320-0000 Generators Phone: 209-552--6051 I.�TJrnr r�CrRtneSYSTEMS INC U.S.EPA ID Number TXR00008120S 7.Transporter 2 Company Na a U.S.EPA ID Number 8.Designated Facility Name and Site Address SA Y—KIFFNYS M , INC. U.S. PAID Num er 6000 88TH STREET SACRAMENTO CA 95828 916-386-4913 CA0000084S17 Facility's Phone: ga 91b.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.Nol. 1NON-RCRA FMIRDOUS WASTE, LIQUID o (AQUEOUS PARTS WASHER SOLUTION) Qh G 134 o� bpi 60 Z 2. W 3. 4. 14.Special Handling Instructions and Additional Information �( 1 'a. vo 24H EMERGENCY#800--468-1760-CH/SK/TFI-Contract retained by generator confers agency au'thorit on initial transporter to add or substitute additional transporters on generator 's behalf. 15. GENERATOR'S/OFFEROR'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 )(if I am a small quantity generator)is true. Generator's/Offeror's Printed/Typed Name Signature Month Day Year 16.International Shipments ❑Import to U.S. ❑Export from U.S. Port of entry/exit: I.- -3 Transporter signature(for exports only): Date leaving U.S.: W 17.Transporter Acknowledgment of Receipt of Materials Tr sporter 1 Printed/Typedpme Signa Month Day Year Z Transpo rinted/Typed Name S onure Month Day Year Pei 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Partial Rejection El ❑Residue � El Full Rejection Manifest Reference Number: 181b.Alternate Facility(or Generator) U.S.EPA ID Number J U LL Facility's Phone: H18c.Signature of Alternate Facility(or Generator) Month Day Year Q z N19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) D 1 H141 2. 3. 4. 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a P' ped ama ' Si e 'n Month Day YTea/rte 1 — ) Ef J go 40 J i 17) Previous editions are obsol e. IGNATED FACILITY TO EPA's e-MANIFEST SYSTEM