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, r <br /> ,re of California—Environmental Protection Agency <br /> /arm Approved OMB No.2050-0039(Expires 9-30-99) See Instructions on baek�e 6. Department of Toxic Substances Control <br /> Please printbr type. Form designed for use on elite(12-pit, &8 5—01 Sacramento,California <br /> •' <br /> UNIFORM HAZARDOUS 1. Generator's US EPA ID No. Manifest Document No. 2. Page 1 Information in the shaded areas <br /> WASTE MANIFEST 0 <br /> is not required by Federal law. <br /> •A 0 0 9 2 <br /> 3. Generator's Name and Mailing Address H, J HEINZState-Manife"st Docvmeni Number A O '� <br /> 800 S CALIFORNIA 2 `2 <br /> O. BOX 57 <br /> O �B Slcfe Geierator;ID <br /> T49CKTO,N CA 95206 <br /> 4. enerator s Phone{0 9 §32-5759 I <br /> N 5. Transporter 1 Company Name 6. US EPA ID Number C.. State Trcrsporter`s ID[Reserved.l <br /> LO <br /> 00 <br /> o SAFETY-KLEEN SYSTEMS, INC jTOTO0?3pD. Tron5portersPha„e <br /> Op n� <br /> r- 7. Trans ort Co Name J- 8. US EPA ID Number -E StoteTrcnspo�ter's ID[ eserved.] <br /> J «�� "� <br /> 'J 9�11000971 <br /> F. Transporter's Phone <r ..-- <br /> U 9. Designated Facility Name and Site Address ` 10. US EPA ID Number G 5t.te Fccility's ID <br /> .!z 5- � SEE #19 BELOW ! , <br /> 1 O i' H. Facility's Phone - ”} <br /> J W <br /> J _ <br /> 12. Containers 13. Total 14. Unit 3 <br /> V 11. US DOT Description(including Proper Shipping Name,Hazard Class,and ID Number) No. Type Quantity Wt/Vol 'h Waste Number <br /> Z a. - <br /> -$taie_ <br /> NON REGULATED LIQUID _ <br /> GEPA/Other <br /> E � T" <br /> ON b. State <br /> coCE <br /> R EPA/Cther <br /> v A <br /> o T C. <br /> 5'ate <br /> co O _ <br /> R •• - _ EPA/OtherLU — <br /> � _ <br /> d. :.State <br /> Z <br /> W <br /> U I I EPA/Other <br /> W <br /> v7x1d banal D@�ci ltp f#oa'f�(hfesgats"Csswed T+s ° c <br /> lfs .P 4 s K Handling Codes for Wcstes Lstea Above <br /> 'w, �..qy, '''s,A,'S�read ,fir„ <br /> Ot�l .'�*? '� cc F'' cx 4 ar <br /> Wi'LI f ++ t k• Mill, <br /> C. <br /> Q _r,�.efF.a 4S` >�r...3�i x��",•: ��aTr�T. .';i�S. �, -_ r`.tu'ar.7' .'r. 4 '� <br /> 0 15. Special Handling Instructions and Additional Information <br /> a MFST R/T##104716415 0002-2481-68 <br /> Z EMERGENCY RESP 800-468-1760( 24 HR ) , IF UNDELIVERABLE RETURN TO GENERATOR, <br /> W SK CORP AUTHORIZED TO RETAIN LICENSED SUBSEQUENT CARRIERS AS NECESSARY. <br /> t- • <br /> 16. GENERATOR'S CERTIFICATION: I hereby declare that the contents oft is consignment are I y an accurately described above by proper shipping name an are classified,packed, <br /> < marked,and labeled,and are in all respects in proper condition for transport by highway according to applicable international and national government regulations. <br /> J <br /> J <br /> IFI <br /> am a large quantity generator,I certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically <br /> Npracticable and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future threat to human health <br /> and the environment;OR,if I am a small quantity generator,I have made a good faith effort to minimize my waste generation and select the best waste management method that is <br /> 0 <br /> available to me and that I can afford. <br /> }. Printed ped Name Si atureMon h Do Ye <br /> Z. <br /> LU <br /> T 17. orter 1 Acknowledgement of Receipt of Materials <br /> R <br /> LU A anted ypecl Name /J�(JsJJt natu nt Yea <br /> W $ ✓" <br /> P <br /> W 0 Tr Acknowle ecei t of Mate els <br /> 0 T Prin e /T me —/ Signature �dpr> �„sp Ye <br /> W E �� Y <br /> D/—�- <br /> V) R CAI <br /> Q <br /> V <br /> F 19. Discrepancy In kation Space ALT., SITE RE—DIRECT' 0618 <br /> Z <br /> A SAFETY—KLEEN SYSTEMS,INC <br /> C 1722 COOPER CREEK RD., DENTON, TX 76208 <br /> i TXD077603371 65124 (940)483-5200 <br /> 20. Facility Owner or Operator Certification of receipt of hazardous materials covered by this manifest except as noted in Item 19. <br /> TPrinted/Typed Name Si nature Month Day Year <br /> Y Q <br /> L <br /> DO NOT WRITE BELOW 6S LINE. <br /> PRQL#k A)0002208878 <br /> SWJoAA M9Q 00240813 8 White: TSDF SENDS THIS COPY TO DTSC WITHIN 30 DAYS. <br /> EPA 8700-22 To: P.O. Box 3000, Sacramento, CA 95812 <br />