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7142 ��nl 111111 mill 111111111 <br /> V 002253848SKS <br /> y <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 7 2 2.Pa 1 of 3. R sY9, 0 <br /> 4.Ma ifest Trackin Nuer <br /> WASTE MANIFEST mb <br /> CAL000]�7349� m �9T!g��0 02 53848 SKS <br /> 5.Generator's Name and Mailing Address Generators Site Address(if different than mailing address) <br /> MIRACLE AUTO PAINTING <br /> 1251 E BIANCHI RD <br /> STOCKTON CA 95210 <br /> Generators Phone: 209-474-3372 <br /> 6.Tj4nyi0 <br /> rlgar,y?9 SYSTEMS, INC. U.S.EPA IDNumber TXR00005*0930 <br /> 7,Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address SAFETY—KLEEN SYSTEMS, INC. I U.14Number <br /> 6000 BOTH STREET <br /> SACRAMENTO CA 95828 <br /> 916-386-4913 CA0000084517 <br /> Facilitys Phone: <br /> ga 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Contairiers 11.Total 12.Unit <br /> HM and Packing Group(if any)) No. Type Quantity WtNol, <br /> 13.Waste Codes <br /> cr X 1 WASTE PAINT RELATED MATERIAL,3, UN1263, DM P DO01 D018 D035 <br /> PG II, I •"Z <br /> l D039 0040 212 <br /> Z 2. <br /> w <br /> O <br /> 3. <br /> 4. <br /> 14,Special Handling Instructions and Additional Information SK SHIP#00795487 50854446 963018 201022 CSG: 24 <br /> '1)ERG#0128; <br /> 24 HR EMERGENCY # B00-468-1760(SAFETY-14LEEN — 94138)' <br /> SK AUTHORIZED TO RETAIN LICENSED SUBSEQUENT CARRIERS AS NECESSARY <br /> 15. GEN ERATOR'S10FFEROR'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 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 <br /> Exporter,I certify that the Contents of thisconsignment conform to the terms of the attached EPA Acknowledgment of Consent <br /> certify that the waste minimization statement identified in 40 CFR 26227(a)(if I am a large quantity generator)or(b)(if I am a sma antity generator)is We. <br /> G ne for sJOfferors PhntedrTypq Name Signatu Month Day Year <br /> U <br /> —J 16.Intemati! <br /> Import to U.S. ❑Export from U.S. Pon of entrylexit <br /> Z ansporter signature(for exports ly): Date leay S.: <br /> W 17.Transporter Acknowledgment of I of Materials <br /> W Transporter 1 Pnnledrryped N Sign r Month Day Year <br /> O !J <br /> ZQ Transporter 2 PnntecUTyped Name Month Day Year <br /> cr <br /> 18.Discrepancy <br /> laa.Discrepancy Indication Space <br /> ❑ Quantity El Type ❑Residue ❑Partial Rejection Full Rejection <br /> Manifest Reference Number <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J_ <br /> V <br /> nai Facilitys Phone: <br /> W 18c.Signature of AVtemate Facility(or Generator) Month Day Year <br /> t— <br /> Q <br /> Z <br /> N19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> Lu <br /> I. 2. 3. 4. <br /> �-1 <br /> 20.Designated Facility Owner or Operator.Certification ceipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Printed/Typed Na t Signature Month Day Year <br /> 1 o <br /> EPA Form 8700-22(Rev.3-05) Previo s editons are obsolete. DESIGNATED FACILITY T ESTINATION STATE(IF REQUIRED) <br /> 1)12607/15Q426 10727.1033 <br />