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r a 1 <br /> SSL SK SHIPq 081019DTSC. a271O\Aj_,1 <br /> - Please_.printpr e.(Form designed for use on elite�(12-pitch)typewriter.) Form Approved.OMB No.'20500039 <br /> UNIFORM HAZARDOUS 1.Generator 10 Number 2.Pa of 3.Em enq Res rase Phoma 4.Manifest Taeking Number <br /> WASTE MANIFEST ' CAD981163967 1—BID-48-176® 10Q396364-1 SKS <br /> 5.Gents stor's Name and Mailing Address Genereoes Site Address(if different Nan mailing address) <br /> Universal Forest Products <br /> 26200 N Nowell -Rd <br /> THORNTON CA 95686 <br /> Generalofs Phone: 209-794-8007 <br /> 6 SAMEWKEE2Na SYSTEMS, INC. U.S.EPA ID Number <br /> rxRe®�eiz®s <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> L--T E2saii �Ze�000 SoSS iS <br /> 8.Designated Facility Name and Site Address ELEAN HARBORS ENVIRONMENTAL SERVICES, IN U.S.EPA ID Number <br /> �. 2247 S HIGHWAY 71, <br /> KIMBALL , ME 69145 <br /> 308-235-4012 NED981723513 <br /> FetliNs Phone: q <br /> g, 9b.U.S.DOT Desoiption InGudirg limper Shipping Name,Hazard Class,ID Number, 10,Containers 11.Total 12.Unit '713.Waste Codes <br /> HM and Packing Group(if any)) Nc. Type Quantity WINcI. <br /> rr X 1 NA3082, HAZARDOUS WASTE, LIQUID DM O � P DOO8 DO18 223 <br /> of Ne O.S,, (LEAD, BENZENE), 9, PG III YQ <br /> z 2. <br /> W <br /> C9 <br /> 3. <br /> 4 <br /> 14.Special Handing Instmdlplleand Addnlonal Information TSD-KP 62400070 UN38094 CSS, <br /> i <br /> 24'HR EMERGENCY 01-698-468-1760 (SAFETY—KLEEN) �¢s'a 6�2 7 3 Of 9 <br /> 15, GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby dedare that the contents of this consignment are fully and accurately described above IN rhe proper shipping name,and are classified,packaged, <br /> marked and Iabeledplacarded,and are in all respects in proper condPoon for transport according to applicable intema5onal and national govemmen�ulations.If ezporl shipment and I am the Primary_ <br /> 'F�porter,I cedfythat me contents of this arraignment conform to the terms of the attached EPA Admorvedgmend of Consent. 1199\fie <br /> I ceniN that the waste minimisation statement identified in 40 CFR 262.27(x)(if I am a Iargg quantity generator)or(b)(it I am a small guantiN eator)is true. <br /> r t Mp�N� Da Year <br /> Genealofs(OBe PnntedRyped Name <br /> � r dc�„t Signatur� �s Y �g <br /> CL Ly 7 ! 6f <br /> .-r16.In atioral Ship enm ❑ rt m p4 <br /> � ImpoU.S. 1 s( � �'` ❑Ezpon from A. Pon of erdry/exit: <br /> Z Tansponer ssgnabure(lor exports only): ' a Date leaving U.S.: <br /> a' 17.Transporter Acknordedgmenl of Receipt of Matenals <br /> Tanspode Anted/Typed Name Signature Month Day Year <br /> g (117 <br /> z Trans qq r 2 Pdnled7Typed Na rgnature Mandy Day Year <br /> k— <br /> 18.Discrepancy <br /> ISa.Disaepancy Indication Space ❑ Quantity 1-1 Type ❑Residue ❑Partial Rejection ❑Fu!Rejection <br /> Manifest Reference Number. <br /> 181b.Altemale Fructify(cur Geneator) - U.S.EPA ID Number _ <br /> J <br /> U <br /> LL Facility's Phone. . <br /> 18d.Signature ofAlternate Facility(or Geneaor) Manlh{ Day Year <br /> Q <br /> Z <br /> 19.H 1}{o'us Waste Report Management Method Codes(i.e.,codes for hasardous vnste treatment,disposal,and recydig systems) <br /> 01. <br /> 1 I ' � 2. � 3. d. <br /> 20.Designated FadliN Dimer or Opeata:CenifmalioA of receipt of haurdous materials coverod by the manifest except as noted in Item 18a <br /> ills PrintedRyped Nam p `/ ' Signatureftyi Mo ay Y <br /> EPA Form 8700-22 are obsolete. DESIGNATED FACL(TYTOG NERATORSTATE IF REQUIRED) <br /> i)7251975 <br /> 11738.1180 <br />