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7-183-01 <br /> Please print or type.(Form designed for use on elitd(12-pitch)typewriter.) Form Approved-OMB No.2050.0039 <br /> UNIFORM HAZARDOUS 1,Generator ID Num r 2 Page 1 of 3.Emergency Response Prone 4.Manifest Tracking Number <br /> CAL000105725 <br /> WASTE MANIFEST l 1 1- 46 1-600-468-1760 001637992 SKS <br /> 5.Generator's Name and Mailing Address ) ; ( Gene r tors$iteAddress(if different than mailing address) <br /> CARGILL ANIMAL NUTRITION <br /> 4344 6 EL DORADO PO �OX 3,6,9 <br /> STOCKTON ( CA 95201 <br /> tortePhone: 2109-9$2-'4132, , <br /> U.S.EPA ID Number 7XRQ00030930 <br /> 6 ? � tft4 �YSTE 0 S# NC. <br /> 1 f ; <br /> 7.I ansporter 2 Company Name ; U.S EPA ID Number <br /> r U.S.EPA lD Number <br /> . 8. )s�,natedFacililyN6meandSrleAiSdZ3'�r.. <br /> . K �$ ���""�N(;, 000760 <br /> CA 95828- CA0000084517 <br /> 6-4Facility's P one: 10.Containers 11.Total 12.Unit9a. 3ti�U.S.DOT Desu pt cn(inducing Pro Sipping k)sterd ss,ID Numbew, 13.Waste Codes <br /> HM 'andPackngGroup(itany)) ! '. Np, Type Quantify Wt Not. <br /> 1 -R80A HA2AREiQI! [111 G 134 ` - <br /> �.. t o UE S. PARTS... R LUTA )D - <br /> w �-.�. I Q <br /> z 2. ' r , <br /> 3. <br /> 1 <br /> 4. <br /> r <br /> 14.Special Handling instructions andtion SK TRCKN/10196167 0038145314 0000371754 0903 24 <br /> r <br /> .7 <br /> SK AUTHORIZED TO RETAI LICENSED $U88EDUEMT CARR RS A$ NECESSARY <br /> 15. GENERATOR'810FFEROR'S CERTIFICATIO 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 labeledlplacayfted,and are in all re peck in proper condition for transport aarordmg to applicable intemalwaland national governmental regulations.If export shipment and t am the PrimaryExporter,I certify that the contents of this consi ment conform to the terms of the attached EPA Acknowledgment of Consent. <br /> I'certity that the waste minimization statement ntifiied in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a small quantity generator)is We. Month Y r <br /> Generaloesl011' or•s Printed/Typed Name Signature <br /> mow" ;ElExpoonfronm1 <br /> _j 16 International Shipments Impod to t�.S. . Port of entrylexit: <br /> ZDate leaving U.S. <br /> Transporter signature(for exports only): <br /> W 17.Trar+sporerAc <br /> tknowledgment of Receipt of Malen s <br /> Tr rt tea <br /> 1 OfTi—pe`dN ign I✓l MonthDay P <br /> t ' 4?1' ��� Month Day Year <br /> 2 Transporter 2 pripledlTyped Name Signature <br /> H <br /> 18.Discrepancy <br /> ❑ <br /> ' Type ❑Residue LJ Partial Rejection ❑Full Rejection <br /> 186.Discrepancy Indication Space Quan <br /> Manifest Reference Number: <br /> 18b.ARernate Facility(or Generator) U.S-EPA ID Number <br /> U <br /> Facility's Phone: - Month Day Year <br /> LU 6c.Signature cf Allemale Facility(orlGenianalec) <br /> LU <br /> : 51flDdes(i.e,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 3. <br /> H141 <br /> 4. <br /> 20,Designated Facility Owner or Oper%pr.Ca4fica6 of receipt of hazardous materials covered by the manifest except as in Sem 18a Month Day Year <br /> Print S* <br /> t i <br /> h Pq� g Q 2 ev.3.05) Previous ed�'tIons a e obsolete. ESIGNATED ACILITY TO GENERATOR STATE(IF REQUI ED)- <br /> x4 . .)084 4 .. ) 3) 4Y <br />