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i � IIIl111111lIIIIIIIIIIIIIIIIlIIIIIIIIiHI <br />7142 00321 0347-s KS <br />Please print or type. (Form designed for use on elite (i2 -pitch) typewriter) Form Approved. OMB No. 2050.0039 <br />UNIFORM HAZARDOUS 1, Generator ID Number 2. Pa g 1 of 3. Erne ency Re se P e 4. Manifest Tracking Number <br />CAL000275412 1-8 i0-4�"-1 .0 003210347 SKS <br />WASTE MANIFEST <br />5. Generator's Name and Mailing Address Generatods Site Address (if different than mailing address) <br />MCNEILUS TRUCK. <br />310c1 N n Art Rd EC E I Y E I) <br />Stockton CR 95215-2218 <br />Generetor'sP.hone: 209-931--4282 <br />6.VAf'Y'F998SY5TEMS, INC. Ot?f; u.S.EPAIDNumber <br />0'7 2niq I TXR000Q150930 <br />8, Designated Facility Name and Site Address SAFETY-KLEEN SYSTEMS INC14EAt,li'N►1eOAo-r;Acnn'"740"'"°ill E <br />1722 COOPER CREEK ROhD <br />DENTON , TX 76208940-483-5200' TXD077503371 <br />Facdiitys Phone: <br />9. i 9b. U.S. DOT DesWpbon (including Proper Shipping Name, Hazard Class, ID Number, 10. Containers 11. Total 12, Unit 13. Waste Codes <br />HM and Packing Group (if any)) No, Type Quantity Wt.Nol. <br />"'NON RCRA HAZARDOUS WASTE SOLID DMP 352 OUTS <br />o (ABSORBENT AND OIL) <br />Z 2, <br />UJ <br />C7 <br />14. Spacial Handling Instructions and Addikonal Information SK SHIP#207310.�W 58069328 10007042 CSS : <br />24 HR EMERGENCY #1-800-4£8--1760 .(SAFETY--KLEEN -- CONTRACT #94138) <br />SK AUTH'D TO USE SUBSEQUENT CARRIERS:41078 41471 81681 82739 85395 <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 govemmenW regulations. if export shipment and I am the Primary <br />Exporter, I caddy thatthe contents of this consignment conform to the temps of the attached EPAAairnowlodgment o€Consent. <br />I certify that the waste minimization statement identified in 40 CFR 262.27(a) (if I am a targe quantity generator) or (b) (if I am a small quantity generator) Is hue. <br />Generatoes/Dffsroes Printoffyped Name Signature Month Day Year <br />✓I 16. d national Shipments <br />❑ import to U.S. ❑ EP«t from U.. ?ort of entryle <br />Transporter signature (for exports only): Date Ieaving.U.S.: <br />17. TranaporterAdmowledgment of Receipt of Materials <br />G6IZ <br />ith Day Year <br />ill, Discrepancy <br />18a. Discrepancy lndlcation Space Quantity ❑ Type ❑ Residue ❑ Partial Rejection ❑ Full Rejection <br />Menifest Reference Number: <br />G 16b. Alternate Facility (or Generator) U.S. EPA ID Number <br />U <br />LL FacillYsPhone: Month Day Year <br />18c. Signature ofAdtemala Facially (or Generator <br />a <br />a ' <br />19. Hazardous Waste Report Management Method Codes (i.e., cedes for hazardous waste treatment, disposal, and recycling syslems) <br />UJ 1.2. 3. A. <br />20. Designaled Fadlily gamer or Operator. CerBfieation of receipt of hazardous materials covered by the manifest except as ndecl in Item 18a <br />y=s PrintedlTyped Name SignatureMonth Day Year <br />dg) Previous editions areabsolete, DESIGNATED FACILITYTO DESTINATION STATE (IF REQUIRED) <br />Page 8 <br />