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.t �j -aI . <br />Ptuncn nrrrlr rk tvnw (From r!acinnwt fnr ilce nn alitn (12•nitrhl Ivoewnterl Form Approved. OMB N0. 2050-0039 <br />rF{ liyooty(�). 3{l5) PWOUS ea daret0=010. UCJIUIVNI CU rHk jL-jI f Iv <br />1) 24254401403141"52 <br />UNIFORM HAZARDOUS <br />t Generator' Number :;')0;3ti417 I f,062. Pegg 1 of <br />3 EQmatt3�e�nc^ynR Phone <br />4. Manifest Traekin Number <br />0 0103 1461 SKS <br />WANE MANIFEST <br />JUL <br />l�f�� 7b�i <br />5. Generatwe�s Name and Madinsq Address Genarator's S,19 Address d dliierent han marl ng address) <br />rFli' ( INES INC <br />CALI9619NIA <br />PO BOX 6245 .3105 5 EL I) )O aT <br />STOCKTON CA 952 <br />Generators Ptwre: 209-466-3554 <br />V9 r�'-' 1L � SYSTEMS, INC. U S. EPA ID Number TX R-000050930 <br />7. Transporter 2 Company Name U.S. EPA ID Num <br />0e--o�P1 79 <br />8. Designated Facility Name and SIIe Address SAFETY-KLEEN SYSTEMS INC. OM618 U S. EPA ID Ntanber <br />1722 COOPER CREEK ROAD <br />DENTON, TX 76208 <br />940-483-5208 TXC077603371 <br />F s Phone: <br />9a. <br />9b. U S DOT Description (irtcludlrp Proper Shipp ng Name, Hazard Class. 10 Number. <br />onda r? 5 <br />11. Total <br />'2, Url <br />13. Waste Codes <br />V,, <br />r, e <br />HM <br />and Packing GroW (d ani <br />aunty <br />N""'CA <br />X <br />1R0 WASTE FLAMMABLE LIQUIDS, N.O.S. <br />0M <br />P <br />0001 <br />211 <br />OUTS <br />o <br />(P-CHLOROBENZOTRIFLUORIDE) <br />3 UN1993 P(3 III (0001) <br />Z <br />2. <br />W <br />C7 <br />3 <br />a <br />:0- <br />L <br />r <br />14. Special Handbng !nstnud* s and Ad6baral informadan SK TRCK1110687567 0080371121 <br />1) EROIi 129 <br />SK 10T)1' R TO I_I -F S(fBSEQLJFNT CARR IERS I 41038 8758 (3168 A 3 <br />. and are clasa, packaged <br />debed above by the proper shipping '�dled <br />15. GENERATOR'SIOFFEROR'3 CERTIFICATION: I hereby declare that the contents of this consignment are fuly and accuxateyla' <br />marked and !abeledlplacarded, and areIn ad respects ,n proper conddon nor Tansporl according to applicable Intematlonal and naWal governmental regufabms. if export sNoment and I am the Primary <br />Exporter, I centity that the contents of'his consignment conform to the temp of the attached EPAAdu,o++liedgment of Consent. <br />I car* that the waste minimization statement denbfied in 40 CFR 267 27(a) (d I am a large quantity generator) or (b) (d 1 am a small quantity generator) s true. <br />Generate sJOfferoh PnntadRyged Name S gnaWro Month Day Ya <br />106 1/ 10 <br />F- <br />16. Intemational Shipments <br />❑ meat to U.S. ❑ Export ltglb U.S. Port of entryleziC . <br />Z <br />Transporter signature (for exports only): / Date teavirg U.S.: <br />CC <br />O <br />17 Transporter of Receipt of Material p� yrs <br />th <br />Trenspatar 1 P nted/i Name „ //', S Gal a--` \ O � ,' t <br />V <br />CIL <br />\ f)' f jLLLyI !/lV/(((! <br />Month Day yes <br />Q <br />Trans nted/Typed Name <br />07' <br />H <br />1.�- <br />18. Discrepancy <br />I Ha. D-saepancy Indication Space El Quantity ❑ Type ❑ Residue ❑ F'wW R*cdon ❑ FW Rejeotlon <br />Manifest Reference Numter. <br />I 8b. Alternate Facility (o Generato) U S EPA 10 Number <br />J <br />U <br />LL <br />Facility's Phone: Month Day Year <br />w <br />18C. Signature of Alternate Facility (o Generator) <br />1Q - <br />Y <br />19 Hazardous Waste Report Management Meow Codes (i.e., codes for hazardous caste treatment, disposal, and recycling systems) <br />o <br />t <br />2. <br />G <br />20 --lesoated Facility bw6r or Operator QeW.4w of receipt of hazardous materials covered by the inamfest except as noted in Ilem'18a <br />PnnteCrrypep Name - i gnalure-) r ♦ Ay ore <br />yr <br />t t ti � <br />e <br />rF{ liyooty(�). 3{l5) PWOUS ea daret0=010. UCJIUIVNI CU rHk jL-jI f Iv <br />1) 24254401403141"52 <br />