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III IIIIIIIIIIIIIIIII I MINE 11111111111111 Please print or e. Form designed for use on elit (12-pitch)typewriter.) $ p r v S X�' P type. 9 P )tYP ) Form Approved.OMB No.2050-0039 1.Generator ID Num er 2.PaW 1 of E ns P 4.Manifest Tracking Number UNIFORM HAZARDOUS CAL000105725 ` MCI��I isl ft 002843826WASTE MANIFEST SKS 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) CAR6ILL ANI t�TRIT ON 4344 S EL DORAD ST STOCKTON CA 95206-4904 Generator's Phone: 209- -?.3 —4439 6•k 1 C U.S.EPA ID Number _ ',fe S Y, TEMS, INC. T tnaf00= 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site A dress FETY-KLEEN SYSTEMS I NC. Ur.&R)!A ID Number 1722 COOPER CREEK R04D NTON, , TX 76208 TXD07760337 940-483 200 1 Facility's Phone: ga. 9b.U.S.DOT Description(inolu Ing Proper Sh ping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes HM and Packing Group(if; No. Type Quantity Wt.Nol. X 1- RQ UN1263 WA E PAINT RELATED MATERIALS D001 D035 D039 0 3 PG II (DQ►01) 7J D040 331 3UTS W �fi1;,02$ BATTERIES D Y CONTAI TING OUTS c� POTA`.SIUM HYD .OXIDE SbLII) 8 PG TI1 � 9,c - PQ 'CADMIUM) (UNIVE SAL WASTE) 3.NOIN PCRA HAZARDOUS WASTE LIQUIDS 223 OUTS 0-11-TARTCAT T NG 31L AN WATER) 2 oa 4. V 14.Special Handling Instructions and Ad itional Inform ion SK SHIP#0.04390068 3387201 1)I=RO#1,28.2)ERG#1J�AOVAE-8-1760 24 HR EMERGENCY # (SAFETY—KLEEN — CONTRACT #94138) 5K ?)'_T:')' ?) o I SE IIBSEQ ENT CARRIERS.41078 41471 81681 82739 853295 15. GENERATOR'S/OFFEROR'S CER IFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, marked and labeled/placarded,and re in all respe is in proper condition for transport according to applicable international and national governmental regulations.If export shipment and I am the Primary Exporter,I certify that the contents of this consignry ant conform to the terms of the attached EPA Acknowledgment of Consent. I certify that the waste minimization statement idem fled in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a small quantity generator)is true. Generat 's/Offeror's Printed/Typed Nam S' n re Month Day Year rTlf� o, -z y -J 16.International Shipments Import S. ❑Export from U. . of entry/e Transporter signature(for exports only): I Date leaving U.S.: W 17,Transporter Acknowledgment of Receipt of Materials Ej Tran rter 1 Printedped Nam Signatur Month Day Year CL v6vt 10 1 � I QTransporter 2 Printed/Typed Name Signature Month Day Year f- 18.Discrepancy 18a.Discrepancy Indication Space Quantity ❑Type Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number 3 Facility's Phone: w 18c.Signature of Alternate Facility(or Genrator) Month Day Year a Z N19.Hazardous Waste Report Management Method Code (i.e.,codes for hazardous waste treatment,disposal,and recycling systems) W 1. 2. 3. 4. 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Year PrintedlTyped Name Signature Month Day EFP1F 22(�e�305) rev' ousace-0, soleteN ST !? .,.. _._� DESIGNATED FACILITY TO DESTINATION (IF REG1UtREo1 4° ET7.��It►� c/�+° 4 � Far.. 5