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03/07/2013 14:57 FAX 12094658060 BULHSTOCKTON@BULK—DTI.CO 20003/0006 <br /> 7142 <br /> Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050 0039 <br /> UNIFORM HAZARDOUS 1 Generator ID Number u 2.Pig 1 of 31Err�r� YF �sa i�p 4- 0033 M pifeB T 1<1 l"urr '4 4 <br /> CALCt00c'967-"1. � U 0C�. <br /> WASTE MANIFEST <br /> 5,Generator's Nam"and Maili r�Address Generator's Ne Address(f different than mailing address) <br /> BULK TRUCKINb <br /> 3032 SD EL DORADO ATTN DE WAYNE C.`OLWELL <br /> STOCKTON CA 95,206 <br /> Generator's Phone: 800—L84-2855 <br /> U.S.EPA ID Number ' <br /> s .� ���°�r�` eSYSTEh15, INC. TXRQt004'1,r-i0930 <br /> 7.Transporter(2 Company Name U.S.EPA ID Number <br /> +V\ C l <br /> Designated Facilly Name and Site Address SAFFTY—KLEEN SYSTEMS NC. U.-7. 1D Number <br /> 1722 COOPER CREEK ROAD <br /> 17ENTON, , TX 762013 <br /> 940-48-2-520177iTXIi077603371 <br /> Facili 's Phone: <br /> 98. 9b.U.S.DDT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes <br /> HM and Pac$dng Group Qf any)) No. Type Quantity WtAol. <br /> X I RP WASTE FLAMMABLE LIQUIDS, N.O.S. DMI' DOO ?11 OUT'S <br /> o (P-CHLDRODEN7.QTRIFLUORIDF) 20PH <br /> 3 UN1933 PG III (D001 ) <br /> z 2. <br /> w <br /> O <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional Information a r H I P4201153773 ,3069669 <br /> 1)ERr# 1128 Z <br /> 24 HP EMERGENCY 111-900-11aA 1.76 (�;AFETY-N�L�VJ--' 94138) <br /> SK AUTH'D TO USE SUBSEQUENT CARRIERS:410713,41471.,81681 82'739,85399 <br /> 15. GENERATOR'S40FFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and acouralely described above by the proper snipping name,and are classified,packaged, <br /> marked and labelediplacarded,and are in all respects in proper condition for transport according to applicable arimallonal and national governmental regulations.if export shipment and I am the Primary <br /> Exporter,I cartlly that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. <br /> I certify that the waste minimization statement identified 4140 CFR 262.27(a)(f I am a large quantity generator)or(b)(if I am a small quantity generator)is true, <br /> enemtor ra nnledlfyped Name bignatureI <br /> Month. y Year <br /> L j <br /> _J 16,international Shipments <br /> Z ❑Import to U.S. Expos fr U.S. Pon of enlrylexil: <br /> Trans 'nature ex oris Date leavin L.S.: <br /> 17. nspaeerAduwwledgmenl of R ipt of Materials <br /> Tra porter 1 Printe yped „ Igoe ure _ ay ear <br /> O r <br /> Z <br /> Transpco pe(1­111V 5 on ay Year <br /> 18.Discrepancy <br /> i <br /> 18a.Discrepancy Indication Space [J Quantity Type ❑Resicue al lion ❑Full Rejection 1� <br /> t <br /> Manifest Reference Number: <br /> 18b.Alienate Fadfly(on Generator) U.S.EPA ID Number <br /> LL Facilit s Phone: <br /> w 18c.Signature of Altemate Facility(or Generator) Mont Day Year i <br /> H <br /> Z r <br /> f <br /> M19.Hazardous Waste Report Management Method Codes(re.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> ud 1. 2 3. 4. <br /> I <br /> 20,Designated Fad li wnW Ops a r Certification o hazardous materiels covered by the manifest exc s ed' Item 18a j <br /> Prinledlfyped Na Signa r Ye i <br /> I! <br /> EP Fir k}pg try4 &r. ous editiOns are obsolete. DESIGNATED FACILITY P11STINATiON§TAT E(IF f: QUIRED) I <br /> I <br />