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7-185-01 Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.D. I Numher 2.Page 1 of 3.Emergency Response Phone 4.Manliest Tracking Number WASTE MANIFEST o.GA't600610949 S�((� 5.Generator's Name and Mailing Address Generators Site Address(if different than mailing address) V 1`V TEMPLE INLAND 400 W VALPICO RD TRACY CA 95376 9197 Generators Phone: 209-836-1971 6.Transporter 1 Com��ppan Name U.S.EPA ID Number SAFETY-RIE'N SYSTEMS, INC. TXR00005093t, 7.Transporter 2 Company Name U.S.EPA ID Number B.Designated Facility Name and SreAddress SAFETY-KLEEN SYSTEMS, INC. 000760 U.S.EPA ID Number 6000 68TH STREET SACRAMENTO CA 95828 Facility's Phone: 916-386-4913 CA0000084517 gra 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit HM and Packing Group(if any)) 13.Waste Codes No. Type Quantity Wt.Nol. r NON-RCRA HAZARDOUS WASTE, LIQUID DM D G 134 o (AQUEOUS PARTS WASHER SOLUTION) w z 2 w 3. 4. 14.Spedal HandNng Instructions and Addifiodal Information SK TRCK#110548646 0039005876 0000370102 0919 25 SK AUTHORT!ZED TO RETAIN LICENSED SUBSEQUENT CARRTERS C NFCPSSARY 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 national governmental regulations.If export shipment and I am the Primary Exporter,I cerify that the contents of Is consignment conform to the tens of the attached EPAAcknowledgment of Consent. I certhe tify that waste minim¢atian ment identified in 40 CFR 262.27(a)(if I am a large quantity generator)or b)y4.am a small qu bty generator is true. Gen retorsl fferm's PdntedrTyped NameSignature Month Day Year i line ( F ? 16.International Shipments f- ❑import to U.S. ❑Export from U.S. Port iintrylexit: Transporter signature(for exports only): Date leaving U.S.: w 17.Transporter Acknowledgment of Receipt of Materials _ - K Traiter 1 Pi mted(Typed Name Sign Month Day Year a C N C Transporter 2 Printed yped Name Sig Monts Da Year" K H 4. 18.Discrepancy .. 18a.Discrepancy indication Space ❑ Quantity ❑Type ❑Residue ❑Partal Rejection ❑Full Rejection Manifest Reference Number: 186.Alternate Facility(or Generator) U.S.EPA ID Number J U LL Facility's Phone: w 18c.Signature of Alternate Fal(or Generator) Monts Oay Year zZ y19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) UP 1. 2. 3. 4. H141 gPnmei8d .DFacility Owner or Operator.Certification of recelpt of hazardous materials covered by the manifest except as noted in Item 18a Name _ Signatu -' Month Day Year 11 0441&- /ipT A EPAF 2 v.3-06)Pievioueditins are ob lee. DESIGNATED FACl TOGENERAT R 1 :0014941 1 ) 4 ;