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: I <br /> � . ;.�• 714x: <br /> writer. Form Approved.OMB N%2050-0039 <br /> Pb�Gtttef tyke.(Form designed for use on elite(12-pitch)type ) p page 1 of 3.Emargf y R se Ph ne_ 4.Ma fe t Tr k{ N/�mbar <br /> UNIFORM HAZARDOUS 1.Generator lD Number CAL00010S-72 1 l �`� -` 1 p` d b `T 013 8 SKS <br /> WASTE MANIFEST <br /> Generators Silo Address{if different Than mailing address} <br /> 5.Generators Name and Mailing Address <br /> CARGILL ANIMAL NUTRITION PU SOX 36? <br /> 4344' S EL DORADO CA 95201 <br /> STOCKTON <br /> Generator's Phone: 209-982-4632 U.S.EPA ID Number <br /> sTanAgadt3rl !> � SYSTF_MS, INC- <br /> 7. <br /> Ier 2 CU.S.EPA ID Number <br /> T.Transportompany Neme <br /> 8,Designated Fa AFETY—KLEEN SYSTcPiS, INC TTAPNumber <br /> U! <br /> 000 88TH STREET'- CA 95828 <br /> r ACRA�IENTO Cl�OQOCiO�'4!7„7 <br /> 916-386-4913 + <br /> Facility's Phone: 10.Containers 11.Total 12 Unit <br /> Proper S Name,Hazard Class,l0 Number, 13.Waste Codes <br /> 9a- 9b.U.S.DOT Descrip)ion(includingt�PP�n9 No.. Type Quantity VYt.Nd. <br /> HM. and Packing Group T any)) ; W1G 134 <br /> 1. NON-RGRA HAZARDOUS WASTE, LIQUID 1 <br /> o (AQUEOUS PA 'TS WAS ER SOLUTION) 1 <br /> ga � <br /> 2. <br /> r <br /> 3. <br /> L <br /> 4. <br /> 14.Special Handling InsWctions andAdditional Inco atlonSK SHIPN20I420603 51866931 371754;' 201032 CSG: 24 <br /> r T : <br /> 24 HR E11ERGENCY ill-80 -468-1760 (SAVETY—KLEEN — 94138) <br /> SK AUTHORIZ D TO RETA N LICENSED SUBSEQU NT CARRIERS AS NECESSARY <br /> 15- GENERATOR'SfOFFEROR'S CERTIFICAT10 : I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are d I a tied,packaged, <br /> marked end fabeledlplacarded,and are in all r pects in proper condition for transport acco(d'mg to apply"International nand nallonal vammental regulations.Il export shipment and I am the Primary <br /> Exporter,I certify that the contents of this cons nment conform to Ore terms)i the attached EPAAcknavdedg quantity generator)is. <br /> I certify that the waste minimization statement i entified in 40 CFR 262.27(a) d 1 am a large fluent ty generator)or am Q Month Day Yeac <br /> Gen eratoeslofieroeg Prrited/TyQed Name <br /> -J 16.Intemational Shipments El Export frorn U.S. Port of entrylexit <br /> LJImport to U.S. Date leaving U.S.: <br /> Transporters <br /> 17.Trans et Ackriowledgrnent of Racal of Materials Month Day Year <br /> S' re <br /> Transpo r 1 Printed/iyped Name <br /> Month Day Year <br /> $Igna Ur <br /> QTransporter 2 Prinle(y I e <br /> r <br /> 19.D'Iscrepancy <br /> r <br /> ❑Residue ❑Partial Rejection Full Rejection <br /> 18a.Discrepancy Indication Space Quantity =` Type <br /> r Manifest Reference Number: <br /> Number <br /> 18b.Alternate Facility(or Generator) <br /> J <br /> v <br /> tai <br /> Month Day Year <br /> Facitity's Phone: <br /> C2 tec.Signature of Alternate TV en to <br /> dour wastg3rea ent,disposal,and recycling systems) <br /> ,,• Haiadou§Wes1e Fig _ Eadee ra.,codes / ff <br /> tron of recei t of hazardous materials covered by the manlest except as in Item 18a onlh D3Y ear <br /> 20.Designated Facility owner or dp4 .Cewfic� D hire /D <br /> P d Name Q 6 <br /> EPA Fgni 87,,22(Rev.3-05� P us edition are obsolete. <br /> Sl NATE FACILITYTO ENERATOR STATE(IF REQUIREQ) <br />