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711W. <br />Form Aooroved. OMB No. 2050-0039 <br />ri— <br />PIIII v, Iypc '� -:, "IYw,. <br />UNIFORM HAZARDOUS <br />.- —.., .... ....... .��............. <br />1. Generator ID Number r f �,I. <br />CADIJ517 P02b <br />2. Pagr 1 Of <br />3� Erry�n�lcy gPsPfYt <br />T t1rL+Y+ ftC <br />4. Manifest Tracking Number <br />002184158 SKS <br />WASTE MANIFEST <br />5. Generators Name and Mailing Address Generator's Ste Adcress (if different than mailing address) <br />UNILFVER <br />1400 WATt:RS_l ROAD ATTN RON NOACK <br />SITICK TON CA 95205 <br />'.._`3�3�+ <br />GenerabrsPhone: <br />6. YM1. 1 << U.S. EPA ID Number T y F1'1271000513930 <br />7. Transporter 2 Company Name U.S. EPA ID Number <br />8 Designated Facility Name and Site Address lig ECOLOGY NEVADA U.S. EPA ID Number <br />it MILES 5 OF MATT <br />?3kA'TTY , NV'?,�I�, <br />Fti11tn••c'S`} .3943 NVI'3:3N1O000 <br />Fadktys Phone: <br />9a. <br />9b• U.S. DOT Description including Proper Shipping Name, Hazard Class. ID Number, <br />10. Containers <br />11. Total <br />12. Unit <br />13. Waste Codes <br />No. <br />Type <br />HM <br />and Packing Group (d any)) <br />Quantity <br />WINol. <br />1 NUN RCRA N.+It�iltl*()US WASI'F: LIGUIOG' <br />OM <br />F <br />NfiNE <br />221 <br />o <br />U.ISE:D OIL. l WATER) <br />- <br />,'s, <br />Z <br />2. NUN :'((_.H, WASTESOLID <br />DM <br />Q <br />(ABSORBEN( AND OIL) <br />3. <br />14. Special Handling Instructions and Adddwal Information 19C 1719 r., riG r <br />24 HR EMERGEWY #1 -800--4GI13 -1760 (SAFETY—KUEN 911 <br />SM PUTHDRIM, ?`) RETAIN LICENSED SLtI;SMUENT CARkIERG (49 NECESSARY <br />15. MERATOR'S/OFFERORS 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 intsmational 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 />1 certify that the waste minimization statement identified in 40 CFR 262.27(a) fd I am a large quantity generator) or (b) (if I am a small quantity, generator) is true. <br />Generatoes/Ofteror's Printed/Typed Name ? Signature Month Day ` Year <br />J <br />� <br />16. International Shipments Imp Iran U.S. <br />❑ ort to U.S. ❑ Port of entry/exit: <br />Transporter signature (for exports only): Date leaving U.S. <br />W <br />17. Transporter Acknav+ledgment of Receipt of Materials <br />Signature Month Year <br />Transporter 1 PrintedfTyped Name x „� <br />i i J <br />Z <br />Transpotter 2 Pdnted/Typed Name Signature ~ Moo Day Year <br />F - <br />1B Discrepancy <br />�1 <br />Ba Discrepancy Indicat on Space ❑ Quantity ❑ Type ❑ Residue ❑ Partial Rejection ❑ Full Rejection <br />Manifest Reference Number. <br />18b. Aftemate Facility (or Generator) U.S. EPA ID Number <br />J <br />rJ <br />QFacilitys <br />w <br />Plane: Month Day Year <br />/8c. Signature of A temate Facility (or Generator) <br />Q <br />z <br />in <br />19 Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recyding systems) <br />0 <br />1 <br />2. 3. <br />4. <br />20. Designated Fatally Owner or Operator. Certification of receipt of hazardous materials covered by the manifest except as noted in Item 1 Ba <br />PnntedlTyped Name Signature Month Day Year <br />EPA Foora�I 7�Q 72 (Re . 3 0� Previous �6an5 are ob§ojete. , uuv�nia t vn a nvr !!A L r.vr r <br />i 1 �y'r'� i t V:.• 1. ,J'1' L ::? 'r: 0'.1' j'J t <br />