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7:185-01 <br /> Please print or type.(Farm designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST CAL000�8798. 1 1-800-468-1760 1001237945 SKS <br /> 5-Generator's Name and Mailing Address Generators Site Address(if different than mailing address) <br /> SAP! I PAK INC <br /> PO BUY•. 1183 23535 S BIRD RD <br /> TRACY CA 95378 <br /> Generators Phone: 209-835-3104 <br /> I-Tnfft1jorppany,plame SYSTEMS, INC. U.S.EPA ID Number TXR000050930 <br /> 7.Transsptorter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address US ECOLOGY NEVADA 050505 U.S.EPA ID Number <br /> 11 MILES S OF BEATT Y HWY <br /> BEATTY NUJ 89003 <br /> 775-553-2203 NVT330010000 <br /> Facility's Phone: <br /> ga 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number. 10.Containers 11.Total 12.Unit <br /> 3.Waste Codes <br /> HM and Packing Group(if any)) <br /> No. Type Quantity Wt.Nol. <br /> 1. NON RCRI HAZARDOUS WASTE : OLID UM P 352 <br /> o ( ABSORBENT AND OIL ) <br /> a � I <br /> W <br /> Z 2. <br /> w <br /> i <br /> 3. <br /> I <br /> 4, <br /> 14.Special Handling Instructions and Additional Information SK TR(.K#.!(J-909222l 0000 2u <br /> SK AUTHORIZED TO RETAIN LICENSED SUBSEQUENT i ARRIERS AS NECESSARY <br /> 15. GENERATOR'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 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 this consignment conform to the terms of the attached EPA Acknowledgment of Consent. <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a small quantity generator)is true. <br /> Generators/Offerors Pnnted(fyped Name / Sig azure r Month Day Year <br /> J 16.International Shipments <br /> ❑Import to U.S. ❑Export from U.S. Port of entry/exit: <br /> Transporter signature(for exports only): Date leaving U.S.: _ <br /> LU 17.Transporter Acknowledgment of Receipt of Materials <br /> Transporter 1 Printed/Typed Name.., Si re � Month Day Year <br /> Z Transporter 2 PrintedlTyped Name Sign Month Day Year' <br /> t- <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> 18b.Altemate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> LL Facility's Phone: <br /> w 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> a <br /> Z <br /> Fn19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> G 1. 2. 3. 4. <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Printed/Typed Name z, Signature Month Day Year <br /> EPR 5ob71AqiM3)-05) Previous editio�t�are obsolete. 4) GENERATOR'S INITIAL COPY <br /> 1)200179215/40277158 <br />