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. � �lllllllllllillfllilllillllllllli�l <br />7142.003a24087SKS <br />Please print or type. (Form designed for, use on elite (12 -pitch) typewriter.} <br />Form Approved, OMB No. 2050-0039 <br />UNIFORM HAZARDOUS 1. Gererator 10 Number 2, Pae 1 Of 3. Erne envy Res nse Pbone 7003824087 <br />nhhsl Tracking.Number <br />WASTE MANIFEST CFILO(>� 7641 '. 1— ^4"8- 1760 SKS <br />5. Generators Name and Mailing Address Generators Site Address (if different than mailing address) <br />MCNEILLIS TRUCK <br />100 N Ad 'Art Rd I'.;TTN.= ' RALPH CO14f• <br />Stockton CA 95215`2 ' <br />_EIVEL <br />Generassm��raasr Phone: 209-931-4282U.S. 0A ID Number <br />$ SAFkTY�KLZEN SYSTEMS, INC. AUGNarne � 7 201PJ TXROOOOS1205 <br />T. Transporter 2 Company Name �' {TA 1. <br />JPA <br />.��. ■a ■rP�DN /4 —tti <br />B. Designated Facility Name and Sate A idress GLEAN HARBORS ENV I R0NMEAiTW 9tN?8?�;A +e ++ U.S. EPA IQ Number <br />87737 2247 7 S HIGHWAY 71 <br />KIMBALL 9 NE 69145 D9 7 { ? <br />3013-235-8200 � N!r!?9811��`.��LJ <br />Facif s Phone: <br />9a. 9b• U.S. DOT Description linduding Proper SUpping Name, Hazard Class, ID Number, 10, Containers 11, Total 12, Una 13. Waste Codes <br />HM and Packing Group (d any)) Na Type Quantity WUWI. <br />O <br />"NONE NON RCRA HAZARDOUS WASH SOLIDS, DM 130C) <br />P 35P_ <br />(CORNCOB ABSORBENT, OIL), N/A <br />d <br />z 1 12 - <br />LU <br />0 <br />14,Special Handling'lnstntctionsand Addition&Informatbn SK 1000704E CSG.; <br />zr os7SL53 <br />a4 HR EMERGENCY #1-800-468-17619 tSAFETY- KLEEN) SS �3 8e9 <br />SH E <br />15, GENERATCR'SIOFFERORS 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 labeledlplaraniad, and are In alk respects In proper condition for transport aocording.lo applicable intemationaland national governmental regulations. If export shoment and 1 am the Primary <br />Exporter, I oudify that the contents of thts consignment conform to the terms of the attacInd EPAAeknowledgmenl of Consent <br />I car* that the waste rninimhation statement Identified (a 40 CFR 282.27(a) (if I am a large quantity generator) or(b) (di am mall quantity generator) is true. <br />Generator f3Re ntedlT� Name I 5sgnai>ge Month Day <br />16 I ati E Shi nts �C <br />r <br />m (' ❑ Import to U.S. <br />❑ Export from U S. Port of entrylexR. <br />Transporter signature (for exports only): <br />Date leaving U.S.: <br />UA <br />17. TranspaterAcknowledgment of Receipt of Malerials <br />Month <br />Day Year <br />UA <br />CLCL <br />Transpc dntedrrypad <br />',U v <br />Sign <br />6 <br />zit r <br />Cn <br />Tra r 2 Printedfryped Name <br />Sig <br />Morrill <br />pay Year <br />tr <br />18. Disaepanq <br />18a. Discrepancy indication Space ❑ Quantity <br />❑ Type ❑ Residue ❑ Partial Rejection <br />❑ Full Rejection <br />Manifest Reference Number: <br />18b. Alternate Facility (or Generator) <br />U.S. EPA ID Number <br />J_ <br />uQ <br />Factlity's Phone: <br />w <br />18c. Signature ofAltemate Facility (or Generator) <br />Month <br />Day Yea{ <br />a <br />z <br />19. Hazardous VPaste Report Management Method Codes (i.e., codes for hazardous waste trealmerri, disposal, and recycang systems) <br />C3 <br />0 <br />1. 2. <br />H040 <br />4. <br />20. Designated Facility Owneror Operator. CerthBplion of receipt <br />of hazardous materials covered by the manifest except d in Item 18a <br />d!T N <br />Signature <br />Mona <br />D Year <br />Pante yped ame / J 8 r3 <br />AY IY- <br />EPA Form 8700-32 (Rev. 305) Previous editions are obsolete. DESIGNATED FACILITYTO DESTINATION STATE_ (IF REQUIRED) <br />1)7369381/40604463 { Page 5 <br />