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Please print or type.(Form designed for use on elite(12-pitc)hpewriter.) Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2 Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST SKS y 5.Generators Name and Mailing Address Generator's Site Address(if di8erent than mailing address) Generator's Phone: 6.Transporter 1 Company Name U.S.EPA ID Number tEl : ltd TXROOOOS0930 7.Transponer2 Company Name U.S.EPA ID Number 8.Designated Facility Name and SileAddmss SAf ETY-KLEEN SYSTEI4S, INC, 000151 i, U.S.EPA ID Number 1722 COOPER CREEK POAD DENTON, 'TX 76208 -'39 ;-'JCu 7X0077503371 Facility's Phone: gin 9b.US.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes HM and Packing Group(if any)) No. Type Quantity Wt/vol, ON RCRA HAZARDOUS WASTE LIQUIDS tM P 40NE 121 dJTS LUBRICATING OIL AND WATER ) z 2. w t7 3. 4. 14.Special Handling Instructions and Additional Information SK TRCK#108450670 0002074214 SUBSEQUE2, ;S Ar 92'' + . 862"'ji 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, marked and labeled/placarded,and are in all respects in proper condition for transport according to applicable international and nabonal governmental regulations.If export shipment and I am the Primary Exporter,I certify that the contents of this consignment conform to the tens of the attached EPA Acknowledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a small quantity generator)is We. Generames/Offeror's PrintedRyped Name Signature Month Day Year 16.International Shipments i ElImport to U.S. ElifromU.S. Pod of entrylexit: Transporter signature(for exports only): Date leaving U.S.: W 17.TmnsporterAcknowledgment of Receipt ofMatwials O Transportenrl Printed/Typed Name Signature Month Day Year 1 N Q Transporter 2 PdntedlTyped Name Signature Month Day Year K r j18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: 181b.Alternate Facility(or Generator) U.S.EPA ID Number J U LL Facility's Phone: w Ise.Signature of Alternate Facility(or Generator) Month Day Year r 2 H19,Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) Wo 1. 2. 3. 4. 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Pdnted/Typed Name Signature Month Day Year EPA Form 8700,42.(Rev.3-05) Previous editions are obsolete. GENERATOR'S INMAL COPY