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Lk <br /> Please print or type.(Form designed for use on elit (12-pitch)typewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Gel erator ID Nu ber 2.Page 1 of 3.Emergency Response Phone F002843665 <br /> Manifest Tracking NNumbberc�[(�WASTE MANIFEST CAL000105725 i .600-,, . . ';v' SKS <br /> V <br /> 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) <br /> CARGIL1._ P1N!M1i., is1.,►'RIT ON <br /> 4344 5 EL DC!Rft ST <br /> 'a:KTON CA 91!52.06--430 , <br /> Generator's Phone: <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> iY:.� MS, INC <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Facility Name and Site A Jdress . AFM--KJ EEN SYSTEN#S I NC Ufa}t yD Number <br /> 722 COOPER CREEK ROOD <br /> BENTON, 76208 <br /> Facility's Phone: <br /> ga, 9b.U.S.DOT Description(indu Jing Proper SI ipping Name,Hazard Class,ID Number, 10.Containers 11 Total 12 Unit <br /> and Packing Group if an ' 13.Waste Codes <br /> HM 9 P(� Y)) No. Type Quantity Nt.Vol. <br /> 1.1.1)'11 �7 sJ;1ai ALGt3 (—`ie 3d,�.ti�1a <br /> Ti. RI <br /> o i mE."FH1*11L I�DPRO D f, 3, PG 1 I, <br /> q R9(DO0 i <br /> UJ 2. <br /> W <br /> C9 _ -- <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Ad itional Inform ition <br /> 1)ERG#tw1 <br /> `4 HR ENtEt NCY 4 —NOa— 68-41768 (SAFETY-+LEEN -- CONTRIPCT #34138) <br /> iT 14* F) T it r 1AC,17 ��11 R SF i.i 7 1•1 <br /> 15. GENERATOR'SIOFFEROWS CE FICATION: 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 resp Is 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 f this consign ent conform to the terms of the attached EPA Acknowledgment of Consent. <br /> I certify that the waste minimization statement ide fled in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(ifI am a gsmall quantitygenerator)is We. <br /> Generator's/Offeror's Priinqnted[Typed Nan Signature Month Day Year <br /> u, O dr r9"e G // <br /> 16.International Shipments <br /> �- Import to U.S. ❑Export from U.S. Y Port of entry/exit: <br /> Transporter signature(for exports only): Date leaving U.S.: <br /> W17.Transporter Acknowledgment of Recei t of Materials <br /> Transporter 1 Printed/Typed Name Signature Month Day Year <br /> O <br /> a <br /> QTransporter 2 Printed/Typed Name Signature Month Day Year <br /> t- <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space Quantity El 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 /> rai <br /> Facility's Phone: <br /> W 18c.Signature of Alternate Facility(or Ger erator) Month Day Year <br /> Q <br /> Z <br /> us19.Hazardous Waste Report Managemen Method Cod (i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> G 1. 2. <br /> 20.Designated Facility Owner or Operator Certification c f receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Printed(fyped Name Signature Month Dav Year <br /> EPA Form 8700-22(Rev.3-05) Previous ditions are solete. GENERATOR'S INITIAL COPY <br />