Laserfiche WebLink
7142I�II <br />003773881 sits <br />Please nrint nr ivnA fFnrm r#ACinned fnr r1,QA nn eiifa r49-nit(,.hl tvnpwriterl P— e—,.4 nNaa ni )nrn-nnno <br />illFs�r�t(3Z(���(�eW ;114P��rmuseditionsareobsolete. DESIGNATED FACILITYTO DESTINATION SATE (IF REQUIRED) <br />3 llL��d �U Page 27 <br />UNIFORM HAZARDOUS <br />1. Generator I Number <br />CALl0i00276412 <br />2. Pail of <br />1 <br />3 t - AF cy Re p nse P oge' <br />�sf1L� 4-1bQi <br />14. Manifest Tracking Num <br />SKS <br />WASTE MANIFEST <br />003773'80'81 <br />5. Generalor's Name and Mailing Address Generator's Site Address (if different than mailing address) <br />MCNEILUS TRUCK <br />3100 N Ad Art Rd ATTN: RALPH CORTEZ <br />StocktDn CA 95215-2218 <br />Geneerralor's�Phone: <br />mp �27l09-931-4282 <br />6 �1-]� fyY'—R �f+f SYSTEMS, INC. U.S. EPA IDNumber 'rXR000081205 <br />7. Transporter 2 Company Name U.S. EPA ID Number <br />8. Desl nated Facility Name and Site Address SAE= ETY--KLEEN SYSTEMS INC. U,S- EPA ID Number <br />7401 1722 COOPER CREEK ROAD <br />DENTgIV, , TX 76208940-483-5200 <br />TXD077603371 <br />Factiltys Phone: <br />ga. <br />gb. U.S. DOT Description (including Proper Shipping Name, Hazard Class, fl) Number, <br />10. Containers <br />11. Total <br />12. Unit <br />13. Waste Codes <br />Type <br />HM <br />(if any)) <br />and Packing GroupNo. <br />Quantity <br />WLA1oi. <br />1NON RCRA HAZARDOUS WASTE SOLID <br />DM <br />P <br />352 <br />OUTS <br />o <br />(CORNCOB ABSORBENT, OIL) <br />- 0 <br />— <br />3101 <br />5. <br />� <br />LU <br />FIECEI�fEU <br />3, <br />AUG <br />0 7 2 <br />15 <br />4. LZ <br />WITU <br />MENIAL <br />.FA! 74",coo <br />pr <br />Ac'NT <br />19. Special Handling Instructions and Additional Information SK SH 10007042 CSG: <br />///� <br />W <br />24 HR EMERGENCY #1--800--468-176th (SAFETY--KLE�t fN CONTRACT #943 W81 <br />SK RUTH"D TO USE SUBSEQUENT GA IERS:41078 41 1.81681.8273%85399 <br />15. GENERATOWSIDFFEROR'S CERTIFICATION: I hereby declare tial the contents of this consfgnm t are fully and accurately described above by the proper shipping name, and are classified, packaged, <br />marked and labaiedlplacarded, end are In all respects In proper con 'lion for transport according pplicable inlem.fional and national governmental regulations. V export shipment and I am the Primary <br />Exporter, i cartify that the contents of this consignment conform to the ruts of the aftachedSK Acknowlodgment of Consent. <br />I codify that the waste minimization statement identified in 40 CFR 2622 a quantity generator) or (b) (if I am a small quantity generator) is true. <br />Generator's! roris PrintedlTyped me Signature Month Day Year <br />X 60�Z 11 173 <br />. Inter Tonal Shipments <br />❑ Import to U.S. ❑Export from U.S. Pod of enlrylexit: <br />Transporter signature (for exports only): Date leaving U.S.: <br />E <br />17,TransporlerAcknowledgmentofReceiptofMaledals <br />12 <br />Transp er 1 PdntedlTypa Name Signatu Month Day Year <br />W <br />�e v 13 . <br />TranPd ledlfyped Namer Signature /J Month Day Year <br />fit <br />18. Dlscrepaney <br />1Be. Discreparicy.Indication Space <br />❑ Quantity 1:1 Type ❑Residue ❑Partial Re)eclion ❑Full ReJectlon <br />Manifest Reference Number: <br />18b.Alternate Facility(or Generator) U.S. EPA ID Number <br />J_ <br />V <br />nai. <br />Facility's Phone: <br />18c. Signature ofNternate Facility (or Generator) Month Day Year <br />a <br />Z <br />19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) <br />LLJ <br />1. <br />i1G <br />20. Designated Facility Owner or Operator: Certification of receipt of hazardous materials covered by the manifest a as noted in Item 1 Be <br />Printed a Name Signal Mont Y <br />7UIb. e <br />illFs�r�t(3Z(���(�eW ;114P��rmuseditionsareobsolete. DESIGNATED FACILITYTO DESTINATION SATE (IF REQUIRED) <br />3 llL��d �U Page 27 <br />