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7142 i • D T. � . r - .— ., <br /> Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.205MO39 <br /> UNIFORM HA2AR000S 1.Generator ID Number 2.Page I of 3.Erne gResponse Phone d.Manifest Trackl Number <br /> WASTE MANIFEST CA1 1-800-468-1760 003210905 SKS- - <br /> 5.Generattor's Name and Mailing Address Generetoes Sim Address(if di8ererd than mal address) <br /> UNIVERSAL-FOREST PRODUCTS <br /> 26200 N Noaell. Rd <br /> Thornton CA 95686 <br /> Geneatots Phone: 209 794-8007 <br /> 6.TSRrtETY�7nEYEN SYSTEMS, INC. U.S.EPA IDNumber TXR000050930 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 6.Designated Facility Name and Site Address SAFETY—KLEEN SYSTEMS INC. UW Number <br /> 1722 COOPER CREEK ROAD <br /> DENTON, , TX 76208 <br /> Fedlitys Phone940-483-5200 TXD077603371 <br /> '. <br /> ga 91b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Cantalnam 11.Total 12.Unit 13.Waste Codes <br /> HM and Packing Group(f any)) - No. Type Ouankty WtNol. <br /> X 1 NA3082, HAZARDOUS WASTE LIQUID, N.O.S. , n DM �/ P I D008 DO 18 223 <br /> o (LEAD, BENZENE), 99 PGIII d/ c <br /> �a OUTS <br /> z 2, <br /> w <br /> e- <br /> 3. <br /> i, <br /> 4, <br /> 14.Special Handling Instructions and Additional mfoonabon SK SHIP#28?9577M 58661282 2892085 CSG: <br /> 1)ERS#171: P2o$p zoz30 <br /> 24 HR EMERGENCY C1-800-468-1760 (SAFETY—KLEEN — CONTRACT #94138) <br /> qK AI jTmqna a <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION:I hereby declare Nat the contents of Nis a0.vgnmel are fully and accurately desenbedtxaveby the aproper shipping name,aid are classified,packaged, <br /> marked and labeledlplaarded,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 /> Fx�cder I certify Nat the contents of this consignment conform to the temw of the attached EPA Aclurm ledgmenl of Consent. <br /> I certify mal the waste minimization statement idegfified in 40 CFR 262.27(a)(d 1 am a large quay ly generator)or(b)(d I am a small quantity generator)is true. <br /> GenemlofslOBerors P' pedrJNa`m — - , c, SignaNre Man Day Year <br /> —l/y (� <br /> 16.lnmm ,zilralShipments4 <br /> F ❑Import to LLS. ❑Expon from U.S. /exit: <br /> = Transporter signature(for exports only): Dale leaving U.S.: <br /> W <br /> 17.TmnspodwAcknoxledgmentof Receipt Materials <br /> Transporter 1 P dlTyped Name T Signet Mon Day Year <br /> �v� USS /? /2 <br /> 4 Transporter rinted(Typed Name Signature _. - Monti Day Year <br /> Id <br /> of <br /> ss a. <br /> i18.Discrepancy . <br /> 18a,Discrepancyindiarion Space ❑ chmi y ❑Type ❑Residue ❑Partial Relectior ❑Fud Rejection <br /> Manliest Reference Number: <br /> lab.Alternate Facility(or Generator) U.S.EPAID Number <br /> 3 <br /> v _ <br /> n Fadi ys Phone: ` - - <br /> w 18c.Sigreature ofAltemate Fall(or Generator) ! Monti Day Year <br /> Q <br /> 2 <br /> N19.Harardaus Waste Repos Management Method Cedes(i.e.,cedes for tuuardous waste treatmert,disposal,and regtling systems) <br /> w 1 t 2 13. 4. <br /> O 1 <br /> 20.Designated Facility Omer or Operator Certification of receipt of hazardous materials covered by the manite except as noted in Item 1 Be <br /> Prin NameSi re Mo Day ear <br /> XON f--Yv EP1Form 8700-22 7041622(/4056)49Eviouseditions are obsolete. ESIGNATEDFA ILITYTOGENERATO TATE(IFREQUIRED) <br /> 11339.0455 <br />