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7-185-01 <br />Please print or type. (Form designed for use on elite (12 -pitch) typewriter.) <br />UNIFORM HAZARDOUS 1. Generator ID Number CAD004771606 2. Page 1 of 3. Emergency Response Phone <br />WASTE MANIFEST 1 1-800-468-1760 <br />5. Generator's Name and Mailin Address Generator's Site Address (if different <br />CALIFORNIA TA�lK LINES INC <br />PO BOX 6245 3105 S EL DORADO ST <br />STOCKTON CA 95206 0245 <br />Generators Phone: 209-466-3554 <br />'Aft ft'LCRLR0 tYSTEMS, INC. <br />Name <br />8. Designated Facility Name and Site Address SAFETY-KLEEN SYSTEMS INC. <br />1722 COOPER CREEK ROAD <br />940-483-5200 DENTDN, <br />Facility's Phone: <br />ga 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, <br />HM and Packing Group (if any)) <br />X 1RQ WASTE FLAMMABLE o LIQUIDS N.O.S. (P-CHLOROBENZOTRIFLUORIDE)' <br />3 UN1993 PG III (D001) <br />W 2. <br />LU <br />0 <br />Form Approved. OMB No. 2050-0039 <br />anifest Tracking Number <br />002184061 SKS <br />TXR000050930 <br />OK)-? <br />000618 U.S. EPA ID Number <br />TX 76208 <br />TXD077603371 <br />10. Containers 11. Total 12. Unit 13, Waste Codes <br />No. I --T—yp,7 Quantity Wt./Vol. <br />DM P D001 211 Ifl <br />14. Special Handling Instructions and Additional Information SK RCK# i 11204291 0000371121 <br />1)ERG#128 <br />24 HR EMERGENCY 800-468-194138) <br />SK AUTH'D TO USE SUBSEQUENT CARRIERS: 40067 41038 82729 85399 87585 <br />15. GEN ERATOR'S(OFFEROR'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, <br />marked and labeledlplacarded, and are in all respects in proper condition for transport according to applicable international and national governmental regulations. If export shipment and I em the Primary <br />Exporter, I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. <br />I certify that the waste minimization statement identified in 40 CFR 262.27(a) (if I am a large quantity generator) (If I am a small quantity generator) is We. <br />Generators/Offerors Printed[Typed Name Signatur Month Day Year <br />.. �"_,_ 12._., IV /I A I / I /- I/k <br />Z- - _ - - - LJ Import to U.S. <br />Transporter signature (for exports only): <br />w 17. Transporter Acknowledgment of Receipt of Materials <br />Transporter 1 PrinledlTyped Name <br />CL <br />Z!) �vR f� S <br />a Transporter 2 PnntedlT ed ma <br />4. <br />18. Discrepancy <br />18a, Discrepancy Indication Space ❑ Quantity <br />18b. Altemate Facility (or Generator) <br />U <br />LL Facility's Phone: <br />w 18c. Signature of Altemate Facility (or Generator) <br />H <br />U Export from U.S. Port of entrylexir. <br />Date leaving U.S.: <br />Sign atu <br />Month <br />Day <br />Year <br />Signat �J <br />Month <br />Day_ <br />Year <br />❑ Type ❑ Residue ❑ Partial Rejection <br />Manifest Reference Number: <br />❑ <br />Full Rejection <br />U.S. EPA ID Number <br />Q <br />z - <br />19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) <br />L, 11- 1 L\ f i t - I2. 3. 4 <br />r& .3-05) Previous itignsareobso te. 4) DESIG A <br />Month Da Y <br />DESTINATION STATE,(IF REQUIRED) <br />