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AN <br />714-2 <br />...i..r,., r.,..e Irmo, ,10 i—d f- ue- nn alit- 117.nitrhl ivnewriler.l <br />s-1tVtivtL <br />AUG ^7� sII�IIIIIIIIIIII�IIPiIIR�lllltl <br />ENVIRONMENTAL Form Approved. OMB No. 2050-0039 <br />I:V h rq� L (tt@Y 1 J rrevlous eamons are vaswere. v Jlurvnr ��r rnvn.� r • v .+�.� • •...,....,.....�... �.. --, <br />I .f _ Page 6 <br />anifestTracklPang I n Number <br />0032 347 SKS <br />WASTE MANIFEST <br />5, Generatces Name and Mailing Address Generator's Site Address (if different than mailing address) <br />MCNEILUS TRUCj! <br />3100 N Ad Art Rd <br />.tacktan CA 95215-2218 <br />Generators Phone: P-09-931-4282 <br />-R ' SYSTEMS, .INC. u.S.EPAIDNumber <br />6. g1Co e TR3 <br />7. Tradspotler2 Company Names ✓ U.S. E^PAJJD Number <br />�ad <br />8. Designated Facility Name and Sita Address SAFETY_K LEC= N SYSTEMS INC. U.,M D Number <br />1722 COOPER CREEK ROAD <br />DENTON, g Tx 76208 <br />940--483-5200 TXD077603371 <br />Facli s phone: <br />ga, <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 PacldngGroup (if any)) <br />Quantity <br />Wt.Nol. <br />1• NON RCRA HAZARDOUS WASTE SOLID <br />DSI <br />P <br />?,52 <br />QUI <br />o <br />(ABSORBENT AND CIL) <br />� <br />410 <br />a <br />2. <br />LU <br />C7 <br />3. <br />4. <br />14. Special Handling lnstruclonsand Additional Information ��,� 5HI1� 2173 `3682 J80C932A 1C�0Q17'12t44 C��• <br />24 SIR EMERGENCY #1-800-468176 SAFETY- -hl - CONTRACT #94138) <br />SK AUTH1 D TO USE SUBSEQUENT GRRCR' 8 ! 1471 81681 8272 B55399 <br />15, GENERATOR'SfOFFROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name, and are dassifled, packaged, <br />marked and labeledlplacarded, and are in al respects in proper condition for transport according to applicable intemaifonal 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 EPAAoknowledgment 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 generator) is li <br />eneratOrs1O11erorS PdntedlTyped Name Signature Month Day /Yeerar <br />f <br />-J <br />16.1 mations Shipments <br />❑ Import to U.S. ❑ Export from U.. Port of antryle <br />Transporter signature (for exports only): Date leaving U.S.: <br />17. TmnsporterAcknowledgment of Receipt of Materials <br />Signatur Month Day Year <br />fl. <br />IL <br />Transporter PrintWypedName C. I� <br />,�c-jZi/N G J <br />QTranspc <br />Pdnte ped Name Signature Month Day Year <br />18. Discrepancy <br />16a. Discrepancy Indication Space Quantity ❑ Type ❑ Residue ❑ Partial Rejection ❑ Full Rejection <br />Manifest Reference Number: <br />16b. Alternate Facility (or Generator) U.S. EPA 0 Number <br />J_ <br />C.7 <br />Faciligfs Phone: <br />W <br />Month Day Year <br />16c. Signature otAllemateFacility (orGenerator) <br />a <br />Z <br />R19. <br />Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling sysiems) <br />LU G <br />1 <br />i <br />1 <br />2. <br />3. <br />4. <br />20. Designated Facility Owner or Operalor: Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br />Printed/Typed Name Signature Month Day Year <br />LZ 1010 1 121 1 <br />r.•.. un�nt <br />I:V h rq� L (tt@Y 1 J rrevlous eamons are vaswere. v Jlurvnr ��r rnvn.� r • v .+�.� • •...,....,.....�... �.. --, <br />I .f _ Page 6 <br />