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1705-0" <br />Pl"%A nnnt ar tuna. (Form desioned for use on elite 112•oitch) Noewnter.) Form Approved. CM8 No. 2050-0039 <br />T)AS 09 <br />S QQ (RBS. 3 Ob) t'reVt0u5 eotoons aro uvsrneic. F l <br />t)'2423440/40314352 <br />1 Generator 10 Number 2. Page 1 ok'3 m R Manifest Tracking ►hselber <br />UNIFORM HAZARDOUS CA0004771 F 1Jb t1 (� f' <br />(� <br />51 S <br />WASYE MANIFEST j F 1`. _ r V V J .1 V A <br />5 Generators Name and Mailing Addressiss!:f d rlerent m address) <br />COLIFORNIA TANK LINES INC <br />PQ hOX 6245 3105 S EL DORADO S T O C fi 8 2009 <br />S t OC;(T(]N CA 95206 0243 <br />09-466- 3554 <br />GeneraWs Ph": <br />6;9�`�°�L �YSTEMS, INC. By EPA IO Number TX R000050930 <br />7 Transporter 2 Company Name U.S. EPA ID Number <br />ev <br />,q a 1 0 <br />6. Des ated Facility Name and Site Address SAF ETY-KLEEN SYSTEMS INC. 000618 U.S. EPA ID "Oer <br />1722 COOPER CREEK ROhD <br />PENTON, TX 76208 <br />940-483-5290 TXD077603371 <br />Faun s Ph": <br />ga. <br />9b. U.S. DOT Description (including Proper SMppirg Name, Hazard Class. tD Number. <br />10 Containers <br />it. Total <br />-. ''^'t <br />13 'Neste Codes <br />140. <br />Type <br />HM <br />and Packing Group !4 anY)) <br />Quantity <br />X <br />IRIS WASTE FLAMMABLE LIQUIDS, ill-O.S. <br />DM <br />P <br />D001 <br />211 <br />OUTS <br />a <br />(P-CHLOROBENZOTRIFLUORIDE) <br />3 UN1993 PG III (1;001) <br />z <br />2. <br />w <br />0 <br />3 <br />3 <br />14ipeOatHand" InSUUC:ion3andAdditbnallrf-Icon :,K TRCK#11.,0884836 •�)0r90371121 <br />1 ERG#1?8 <br />SK AUTH'D TO USE SUBSEQUENT CARRIERS: 41038 87585 81681 82739 85399 <br />15 GENERATOR,SJOFFEROR'S CERTIFICATION: I hereby declare that to contents of this consignment are kitty and accurately described above try "provername. and are classified, packaged, <br />shipment and I am the Primary <br />marked and Iabei"placarde d, and are n all respects in proper condition for transport according to applicable ntemational and national govemmental r / exp <br />EPA Adrrw of Consent <br />Expor er. I certify that ft contents of this consig~ conform to the terms of the attadted edgment <br />statement Bended in 40 CFR 26Z77(a) (it I am a wge quantity generator) or ib 4i arty( small q*bty ger is / <br />car* that the waste minimization <br />Generali(b s PrinteCyped Name I. Signatuy►. / / Month Day Year <br />w <br />16. Intemational hipmentaImport b U.S ❑Export from U.S, �..: Pat of en"lisi tt <br />Transporter signature ifs exports only): Dots keavirg U.S.: <br />W <br />17 Traropgrier Acknowkedgrnent of Receipt of Materials m MDay Year <br />OTranepoft <br />I PdnIONTYped Name Sgnae <br />a <br />l13 r<c c <br />Trainsparer 2 P ntedR Name Sign a Day Year <br />`I <br />'4 <br />i �I - <br />16. Discrepam <br />I Ba- Discrepancy Indication Space Quantity ❑ Type ❑ Residue ❑ Paroal Rejection ❑ F,dl Ralect on <br />Manifest Reference Number. <br />U.S EPA ID Number <br />I fib. Alternate Facility (or Generator) <br />U <br />Fauiity's Pone. Month Day Year <br />w 1 Be. Sgsature of Alternate Faauty for Generates) <br />t— <br />Q � <br />19. Hazardous Waste Report Management Method Code ii.e . codes for hazardous waste treatment disposal, and recycling systems) <br />a <br />i <br />I <br />3, <br />4 <br />20 Designated F IIy Owner or Operator C401ka Of receipt of hazardous matenals covered by the rnvtfest except as noted d !tem 198 <br />Day Ynar <br />Pnn!eru ype!d Name Signature ,1p„m <br />t' <br />neeiCBteTCn Gerd ITV T(1 C;FNFRATOP <br />T)AS 09 <br />S QQ (RBS. 3 Ob) t'reVt0u5 eotoons aro uvsrneic. F l <br />t)'2423440/40314352 <br />