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0 <br />7142 <br />PIPasa nrint nr tvne. (Form desianed for use on she (12 -pitch) typewriter.) <br />• iiiumiiuiWiu�wiuiiuiusi <br />Form Approved, OMB No. 2050-0039 <br />tNAhorm ti/lTU-2k (tiev. J-1)9) YreviCiVs MEMO areoDSoleie. rJCblulw-ki CU r141'rL11 1 Iv vCa r 11MM11V 01#%1 G trr nv-Mw1n"wj <br />1)400056/12306 Page 12 V <br />UNIFORM HAZARDOUS <br />1. Generator ID Number 2: Page 1 of 3. Emer ency Res onse Phone I,, mannesr ira'xing numoer <br />CAL000276412 1 1--80-4€1B-1760 003324090 SKS <br />WASTE MANIFEST <br />5. Generators Name and Mailing Address Generatofs Site Address (if different than mailing address) <br />MCNEILUS TRUCK <br />3100 N Ad Art Rd <br />Stockton CA 95215--2218 <br />Generators Phone:. 209-931-4282 <br />6. Trans orter 1 Com an Name U.S. EPA ID Number <br />SA), Y -KEEN SYSTEMS, INC. TXROO@081205 <br />7. Transporter 2 Campy Name U.S. E`P'A ID^�Number <br />-,- 6 <br />�\o,� -v Q 0,� �� \LJ r%\4n "-- --(� <br />8. Designated Facility Name and Site Address AFETY-KLEEN SYSTEMS I NCS U.S. EPA ID Number <br />7401 1722 COOPER CREEK. ROAD <br />DENTON, � , TX 78208 <br />940-483-5200 TX'D0776033371 <br />Facilih/s Phone: <br />ga <br />9b. U.S. DDT Desoriptien (including Proper Shipping Name, Hazard Class, ID Number, <br />110. Containers <br />11, Total <br />12. Unit <br />13. Waste Codes <br />No. <br />Type <br />HM <br />and Packing Group ff any)) <br />Quantity <br />WLN01. <br />0� <br />"NON RCRA HAZARDOUS WASTE SOLID <br />DM <br />P <br />352 OUTS <br />121 <br />o <br />(ABSORBENT AND OIL) ' <br />� 00 <br />� <br />w <br />2. <br />3. <br />4. <br />14.SpodalHandlinginstructions and Additional Information SK S P�� 10007042 CSG-.. <br />za-�. r�z <br />24 HR EMERGENCY #1-800--468-1760 SAFET -KLEEN CONTRACT #94138) <br />15. GENERATOR'SIOFFEROR'S CERTIFICATION: f hereby declare that the Donlan s o nsignment are fully and accurately describe above by the proper shipping name, and are classified, packaged, <br />marked and labeledlplacarded, and are In all respects in proper condition for transport according to applicable international 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 EPAAcknowledgmentof 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 true. <br />Generalorsl0ff Printed(T ped Name ry ` Signature Month Day Year <br />r3 <br />1= <br />11f. Inlemational Shipments <br />❑ Import to U.S. El Export from U.S. Port of entrylexit: <br />z, <br />Transporter signature (for exports only): Date leaving U.S.: <br />17. TransporterAcknoVedgment of Receipt of Materials <br />a <br />Transp er 1 Printed(ryped me Signature Mont Day Year <br />o <br />a <br />� �3 <br />QT <br />tier 2 Printedlfyped Name Signetur Month Day Year <br />`�" yr\,rte e1�1-1 t 1 "i <br />18. Discrepancy <br />18a. Discrepancy In4icatlon Space Quantity ❑ Type ❑ Residue ❑ Pallial Rejection ❑ Full Rejection <br />Manifest Reference Number: <br />18b. Alto male Facility (or Generator) U.S. EPA ID Number <br />J <br />V <br />LL <br />Facility's Phone: <br />w <br />18c. Signature of Alternate Facility (or Generator) <br />Month Day Year <br />a <br />z <br />19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recyding systems) <br />20. Designated Facility Owner or Operator:.Certification of re €pt of hazardous materials covered by the manife Dept as noted in Item 18a <br />Printed ame N ' � 5 y <br />tNAhorm ti/lTU-2k (tiev. J-1)9) YreviCiVs MEMO areoDSoleie. rJCblulw-ki CU r141'rL11 1 Iv vCa r 11MM11V 01#%1 G trr nv-Mw1n"wj <br />1)400056/12306 Page 12 V <br />