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0 <br />7142 <br />L1 x..........14 <br />� IIIIII�IIIIIRIIMIIIINIIVIAIIII <br />Fnrm Annroved. OMB Na2050-0039 <br />EPA Form 81OU-22 (Hey,3-Vb) Previous eal8ons are ODSolete. Ut:5I UNAI t:U rA:iILI I Y I U Ute^, IANAI WIN a 1A r ti ric turnmul <br />1)400056/12306 lL.!/ <br />Page 13 <br />UNIFORM HAZARDOUS <br />1. Generator ID Number <br />CAL000276412 <br />2. Page 1 of 3. Enver ency Res Dose Phone <br />1-8 �-4 6-1760 <br />4. Manifest Trackin Number <br />0 0 3 3 4 0 8 9 SKS <br />WASTE MANIFEST <br />5, Genarators Name and Mailing Address Generator's Site Address (if different than mailing address) <br />MCNEILUS TRUCK <br />3100 N Ad Art Rd <br />Stockton CA 95215-2218 <br />Generators Phone: P-09-931-4282 <br />6. Tom1 Compan Name U.S. EPA ID Number <br />SA ETY—KL EN SYSTEMS, INC. TXROOOO81205 <br />7. Transporter 2 Company Name U.S. EPA ID Number <br />8. Designated Facility Name and Site Address SAFETY-KLEEN SYSTEMS INC. U.S. EPA fD Number <br />7401 1722 COOPER CREEK ROAD <br />DENTON, , TX 762013 <br />940-483-5200 1TXD077603371 <br />Facility'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 13. Waste Codes <br />No. <br />Type <br />HM <br />and Parkin Group if an <br />9 P ( Y)) <br />Quantity <br />h' <br />WtNol. <br />1. NON RCRA HAZARDOUS WASTE SOLID <br />DM <br />P . 352 OUTS <br />0 <br />(ABSORBENT FIND OIL)- <br />2 <br />2. <br />Lu. <br />LU <br />C7 <br />iL <br />3.AUG <br />0 1 2015 <br />4' <br />�� ESN n la�nT+( cMlr <br />14. Special Handling Instructions and Additional Information SK SH P 10007042 CSG: <br />zdy <br />24 HR EMERGENCY #1-800--468-1760 ETY-KLE - CONTRACT #54138? <br />15. GENERATOR'SfOFFEROR'S CERTIFICATION: I hereby declare that the contents of ibis consignment are Wily and accum ety 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 nefional governmental regulations. I export shipment and I am the Primary <br />Exporter, I cerOly that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. <br />I ceftlfy that the waste mKmizat on statement identified in 40 CFR 262.27(a) (if I am a large quantity generator) or (b) (VI am a small quantity generator) Is true. <br />G neratorslolferors 'ntedfryped Name Signature Month Day Year <br />13 <br />�� zz 7 <br />J16 <br />W <br />Interna ronal Shipments <br />❑ import to U.S. ❑ Export from U.S. Port of entrylexit: <br />z <br />Transporter signature (for exports only): Elate leaving U.S.: <br />w <br />17. Transporter AcknoMedgment of Receipt of Materials <br />—WTranspo <br />IL <br />IL <br />r 1 Pdnledlryped me Sign Month Day Year <br />tv�� d3 <br />Z <br />Trans rter2PrinteVype Name S[gnatyj87Month Day Year <br />r <br />18. Discrepancy <br />18a. Dfserepaney lndioa4on Space ❑ Quantity ❑ Type ❑ Residue ❑ Partial Rejection ❑ Full Rejuclion <br />Manifest Reference Number: <br />18b. Alternate Facility (or Generator) U.S. EPA ID Number <br />J_ <br />V <br />Facility's Phone <br />LUa <br />18c. Signature of Altemate Facility (or Generator) <br />Month Day Year <br />M <br />S219. <br />Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) <br />0 <br />i. � <br />2. <br />3. <br />4. <br />20. Designated FaCilty D , qr Operator: ertlilcailon of pt of hazanlous materials covered by the manifest ce as n ed in m 8a <br />f <br />Prinledffyped Name Sig ure M Ih Y <br />EPA Form 81OU-22 (Hey,3-Vb) Previous eal8ons are ODSolete. Ut:5I UNAI t:U rA:iILI I Y I U Ute^, IANAI WIN a 1A r ti ric turnmul <br />1)400056/12306 lL.!/ <br />Page 13 <br />