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7142 <br />! <br />Please pnni or W. (corm aesrgnea <br />ror use on elite (12-pl") +inter.) Form Apg <br />UNIFORM! HAZARDOUS <br />1' ID Number <br />CRL000276412 <br />2. Pa ga 1 of <br />1 <br />3. Eine ency Phone 4. Manffest Tracking Numbs <br />1-80-47601003817406 <br />WASTE MANIFEST <br />L F_: <br />5. Generators Name and Mailing Address Generaiofs Site Address (if different than mailing address) <br />MCNEILUS TRUCK <br />S3100 N TOCKTD ART RD <br />ONCA 95215-2218 ENVIRON <br />Generator's Plwne: 209-931--4282 14FA„ 4 "Ir—PA <br />Transporter 1 Company Nam U.S, EPA ID Numbar <br />SAFETY—KLEEN SYSTEMS, INC. TXR000050930 <br />7. Transporter 2 Company Name US. EPA ID Number <br />8. DesigRated FacilityName aMbileAddress SAFETY—KLEEN SYSTEMS INC. 1d ��itDNumber <br />1722 COOPER CREEK ROAD <br />D#=NTON, , TK 76208 <br />940-483-5200 TXD077603371 <br />Fatil:Hs Phone: <br />9a. <br />9b. U.S. DOT Description onciwN Proper Shipping Name, Hazard C{ass, iD Number, <br />10. Conlaina"Type <br />11. Total <br />12. Untl <br />HM <br />and Packing Group ('d any)) <br />No. <br />Quantity <br />WI.Nol, <br />13. Waste Codes <br />o <br />X <br />t.UN1950, WASTE AEROSOLS, FLAMMABLE, 2.1, <br />DM <br />15%'P <br />D001 <br />3039 <br />331 - <br />OUTS <br />LU <br />2. NON RCRA HAZARDOUS WASTE SOLID <br />DM <br />P <br />80V i <br />352 <br />TS <br />(ABSORBENT AND OIL) <br />3. <br />4. <br />W. Special dandling Inshn*ons and Additional Information SK SH 202765497 5 8722672 10007042 CS(, <br />1)ERG#126 <br />24 HR EMERGENCY #1-800-468-1760 (S TY—K — CONTRACT #94138) <br />17n.jqq <br />15. GENEtATOR'SIOFFEROR'S CERTIFICATION: l hereby dedare Brat the contents of bs consignment are and accuratelydescrbe above by the proper shippkg name, and are dass'tfied, packaged, <br />marked and labeleM acarded, and are in all respects fn proper condition for transport according to applicable international and national governmental regurations. Ifespod shipment and I am the Primary <br />Exporter, f certify that Bre contents of this consignment conform to the terms of the attached EPAAckrtawtedgment of Consent <br />I certify that the waste minimizal'mrr statement identfrted in 46 CFR 26227(a) (if I am a large quantity generator) jr (b) (If I ain a smart quanttly ganeraloqjvIve. <br />GeneraWd ros Printedli a e o Year <br />_j <br />F <br />t6. Int( motional Shipments <br />ro. Port of enbyk>at , <br />❑ Import 10 U.S. ❑Expo t fm . <br />Transporter si only): Date lea ' b.S.: <br />W <br />of tulatadals <br />O <br />re ay ear <br />tT,,,ntAdnowledgmeo <br />Q <br />yped Na rgce ay <br />G' <br />18. Discrepancy <br />18a. Discrepancy lnditatien Space ❑ Ouantty ❑ Type ❑ Residue ❑ Partin Rejection ❑ Ful; Re}et8on <br />Manifesi Reference Number. <br />18b.Alternate Faintly (or Generator) U.S. EPA ID Number <br />7 <br />V <br />Fadli s Phone: <br />a <br />182 Signatureof Allemate facility (or Generator) .Month Day Year <br />a <br />z <br />y19. <br />Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste Vestment, disposal, and recycling systems) <br />LU <br />1. 1 <br />2. <br />3. <br />4. <br />2{t. Designated Fadllty Owner or Operator. Certifrcation of receiptof hazardous matedals covered by the manbastexceptas noted in Item 18a <br />ARA <br />M <br />011=�Q <br />Day Year <br />tYA term tsrutr-Xd tKev, o-uoJ DESIGNATED FABUW TO DESTINATION STATE JIF IREQUiRED) <br />1)6996760/40456260 21400056/12306 <br />Page 2 <br />2015, <br />IENTAL <br />:MA!;NJT <br />