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7142 <br /> Please print or type.(Form designed for use on elite(12-pitch)typewriter.) - .;A Form Approved.OMB No.20500039 <br /> UNIFORM HAZARDOUS Generator ID Number 2.Pae 1 of 119046 es nse P " 4.Manifest Tracking Number <br /> CAD981163967 �-1 �� 0031.50904 SKS <br /> WASTE'MANIFEST <br /> S.Generators Name and Mailing Address Generators Site Address(d different than mailing address) <br /> UNIVERSAL FOREST PRODUCTS a, <br /> 26200 N Nowell Rd <br /> Thornton CA 95686 <br /> Generators Phone: 209 794-8007 <br /> 6 1 N e U.S.EPA ID Number TYCO A 4UQ� <br /> SYSTEMSq INI <br /> 7.Transporter 2 Company Name U.S.EPA 10 Number <br /> e.Designated Facnity Name and Site Address US ECOLOGY NEVADA 1LW M0 Number <br /> 11 MILES S OF BEATTY HWY 95 <br /> BEATTY q NV 89003 N <br /> 800-239-3943 VT330O1O000 <br /> Facil:tys Phone: <br /> z <br /> ger 9b.US.DOT Descriptor,(including Proper Shipping Name,Hazard Claw,ID Number, 10.Conuiners 11.10121 12.Unit 13.Waste Codes <br /> HM and Packing Group(if any)) No, Type Quantity Wi <br /> NON RCRA HAZARDOUS WASTE SOLID DM P 352 <br /> o (ABSORBENT AND OIL) <br /> 25r® <br /> Z 2. <br /> W <br /> C7 <br /> 3. <br /> 4, <br /> 14.SPecial Handling Instructions and Additional information SK SHIPO 2892085 CSGS <br /> Z!� yc � >y <br /> 24 HR EMERGENCY #1-800-468-1760 ET <br /> (SAFY-KLEEN - CONTRACT #94138) <br /> SK AUTHORIZED TO RETAIN LICENSED SUBSEQUENT CARRIERS AS NECESSARY <br /> 070140600-7015 <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby deciare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,p 3a'g d <br /> narked and labeledlplararded,and are in as respells in Proper condition for transport according to applicable intemaaonal 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 terns of the Attached EPAAcknoMedgmem of Consent <br /> I daily Oat the waste minimization statement identified in 40 CFR 262.21(a)(if am a large quantity generator)or(b)(flinn a small gwntily generator)is true. - <br /> Generata'stOBerors FdnteMyped Namfl_. SgnaWm ,[/J� ) - Month Day Year <br /> Hfts /6719 1 y ` <br /> J .International Shipments <br /> � ❑Import to U.S. ❑Export from 115. _ _ Port olemry/e>'dt . <br /> = Transporter signawre(for expors only): Date leaving U.S.: <br /> W 17.Transporter Acknowledgment at Receipt of Materials ,r,. <br /> O Trans 1 Prin yped 1 _ Signature Month j r _ Month Day Year <br /> Z <br /> 4 <br /> Transporter 2 Frei IIII armor �j tv t/ nawre Doth Day Year <br /> ` <br /> j18.Discrepancy l <br /> 18a.Discrepancy Inciipgon.Spaco ❑ Quantity ❑Typa F ❑Residue ❑Partial Rejection - ❑Fun Rejection <br /> Manifest Reference Number: <br /> 18b.Abemate,Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U ' <br /> LL Fadliys Phone: <br /> w t6c.Signature of Alternate Fadiity(or Generator) Month-" Day Year <br /> Q <br /> y 19.Hazardous Waste Repent Management Method!Codes(Le.,codes for hazardous waste treatment,disposal,and regcing systems) <br /> 3. 4. <br /> 2g.Desgnaled FacilityOwner or 0peralor Certification of receipt of hazardous matedals covered by the manifest except as noted in Item 18a <br /> 1 Printedrryped Name Sgnal Monty Day Year <br /> EPA Form 8700-22(Rev.3-0g Previous editions am obsolete. D � ATED FACILITYTO GENERATOR STATE(IF REQUIRED) <br /> 1)400056/12302 11318.0873 <br />