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05/09/2011 12:43 2095453680 SAFETY KLEEN <br /> • • PAGE 02/03 <br /> 7-185-01 <br /> Please print or I a. Fondle ned for uaR on stile 12•plfch)rypewrller. <br /> UNIFORM HAZARDOUS 1.GeremlorNNumbm 2.P of 3.Emergent Ros Form Appmwd.OMD No.2050-0039 <br /> WASTE MANIFEST CAL000216288 Y pwree Phone 4.Mg/n�IloR Tracking Number /� <br /> a.GFMMIw'SNnmOand Maul ll9naalp.2 — 001509980 SKS <br /> ALLIED WASTE Gmerelgr'e 98eAtltlrn;s QldRwem then malnnq ondreaa) V Y <br /> 1145 W CHARTER WAY <br /> STOCKTON CA 95206 <br /> Omelat'a Phom: 209-462-6009 <br /> 6us <br /> SRFETY K E N SYSTEMS, <br /> INC. U.e.EPA to Number <br /> r,Tmnspal(Q'2Oomperry Now TXROOOO509 30 <br /> D.S.EPA ID Number <br /> 8.09sp (ad FecirtyNameand 84,Address SAFETY-KLEEN SYSTEMS, INC, G <br /> 1722 COOPER CREEK ROAD 000618 D$.EPA ID Number <br /> 940-483-5200 DENTON, TX 76208 <br /> FedNyra Phone: TX0077603 371 <br /> Sn, 9b.U.S.DOT Daatripfim(NiULdr y ProperShlpping Nama,I•Imead Class.ID Numher. <br /> MM and Pachlnp Group(if my)) 10.CpnsiMom 1f.Total 12,Unll <br /> Na. Type Quarry, WI.Abl. 13.Whole Codas <br /> o X HDISTDL ATIONOUS TBOTTOMS)9 UN 082 PGIII DM <br /> P D006 Do07 0008 <br /> � D006, 0007, D008) --- <br /> w 2. 12- 252 OUTS <br /> c� <br /> e. <br /> fa.SpedN Handfing lnstnslions andAddlanel lmomrstlon SK CK#1100057 6 W <br /> 1)ERGY171 0003051916 <br /> RUILL <br /> 15. GENERATOR'S IOFFEItOR'S Cnd Ira CA TI ON: here6ydeclam lhil lha canlmWof lhle mnslpnment weN ymaatwm mlytleecdbed A6o9e by NC D1 fehi n namq,amd mtl cMsslfied,packaged, <br /> Exporksnd leheletl/pleCRNed,and ere In all respects In proper cgnMUonwlramorm eacerdong to APPI"Ns lnlamellaneland nalmnel p�9 <br /> Expmnw,lcemry that the 000019 of Ho conslgnmmnt mnfarm m tho Nims of tho e8echod EPAAcknmwddgmnnl a(Cmoam. gowmmamal maotglbng. sxPan shlpmanl antllam lhaPmery <br /> I cedlfy lhel the waste commIeglmn alslemant ldenlltled In 48 CFR 292.E7(a)of l am a Nfge quanta manow,orb) Mao II amt <br /> enttglar'sro8erora Pin; dlrynml sl�a quantity <br /> ) ( W rygmerslprJ kfrx. <br /> :Mmth On Yoer <br /> y <br /> lep <br /> 16. rnwlmel L <br /> Npmmle �Impwl to U.S, V <br /> ? Trem;WtOrsIgnatum(for oxport"n ©E�DR 1ron1 Port mtsmryle da <br /> w 17,TrsnapngarAtltnavkdpmeM q(Recelpl mlMRladak• Data Ieving U,S.'. <br /> oTransom dile fflyped Name Slprrelura <br /> N !Month Day You <br /> Tre spm ergPrinled ypetlName 6 ve <br /> C, <br /> e- Sbrwl (Month pay Year <br /> 18,ohcraPancy a, <br /> 18e.Discrepant'lndknllmn Space ©edmaly Typo <br /> ©Rasdue ❑Pnnkl RRJotlion ©FUII Rejadlan <br /> feb.A Wmnle Fadk(y(w GP.narabr) M+NfRsl flgmrenua NLmber, <br /> -� U,$,EPAIDNumber <br /> era. raaJrity't Ph"o, <br /> 18c,Sipnalurs olAllsmalo Fadltly(w Ganereloq <br /> r ' <br /> Month Day Yaaf <br /> y19,HRaldoua Waa1s R ped ManPpmmenl Method Codes 0.e,.Callao 16,heeerd"weal,ImnlmCAl,dispoeel,and rem/eFllp:ysllmce) <br /> i <br /> 20.0 Ion Fadllty Ownwar Cpemisn Csr110utlon or rarppl pfmzerdmue mRlstiml5 ravcrod b)'Iha manl(aM to ended lna 1188 <br /> Prin pod Nemo Go <br /> Month <br /> 99 URY Y <br /> EPA Form 700.22(Ray.. 5) Previous editions era oUsokle. <br /> 1)0003715 2) 3) 4) DES NATEp ITYTODESTINATIONSTATEtIFpEquJRED) <br />