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.,1.`.y <br /> Please <br /> Form Approved.OMB No.2050-0039 <br /> print or type.(Form designed for use on elite(12-pitch)typewriter.) <br /> 1.Generator ID Number 2.Page 1 I!F=- <br /> 4.Manifest Tracking Number <br /> UNIFORM HAZARDOUS �; �.4tdL7!�9�5�"2121i411 1. �WASTE MANIFEST `°�6 81 SKS <br /> 5.Generator's Name and Mailing Address Generators Site Address(if diferent than mailing address) <br /> sal En i ELL <br /> 3003 E HAMMER LlIq <br /> Generator's Phone: 209-956 475 1 U.S.EPA ID Number <br /> 6.Transporter 1 Company Name TX R 0 0 0 05 0930 <br /> D FEt Y-KLEEN SYSTEMS, 4)NIC <br /> U.S.EPA ID Number <br /> 7,Transporter 2 Company Name ,, - r <br /> '�'�k� �- yf: ,1 .`n�'r�;f?.�',�;f lr a f�• �". ���.. !-,.<' ex <br /> rr�"(rr a' � 'l <br /> l - U.S.-EPCID Number <br /> 8.Designated Facility Name and Site Address =AF 6``--R 1 EEN ,�STEV16, INC- <br /> 1722 <br /> NC- f�}t. <br /> L1�ry2.;+_y.� COOPER i;S�E'rr.. tit.-1 v e _ _ <br /> STEN f MI. et TA Lsfs..R TX�F0 j f GF03 s71 <br /> 940-483-521330 <br /> Facility's Phone: <br /> 9a. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers tt.Total 12.Unit 13.Waste Codes <br /> HM and Packing Group(If any)) No. Type Quantity Wt.Nol. <br /> o 1.HAZPRl`sGU6 WREJE ' 10111 DD € -�b-'Srr LTi ���� P �����5@08 <br /> T} s`,z _tT TtCT.5 LtMvf i r� E.1E3T..l I t i <br /> Baa, J{{�006, l7�t0 ,, DOM ��� �� � <br /> t Lfi-• S.f51... <br /> Z 2. <br /> LU <br /> 3 .. <br /> 4. <br /> 14.Special Handling Instructions and Additional Information ata. - rd!ftiE_r 27es1160 <br /> f <br /> .. .. .. <br /> ?)x,.IEIIt.`s'!1 <br /> ?24 HR ECIERG N ,Y *41-800-468-1760 ;=Ar Y-KLEE v - CONTRACT ,#9 1388 <br /> t~1€T.10PI! hi'. a'`r'�1i tr.-�a.-,m '1i.a f:.?? '�tr=.R1 4k` aCk yn <br /> f� Y:EE-t�f'k Tf't f Et=r� r 7'Y' C <br /> 15. GENERATOR'SIOFFEROR'SCERTIFICATION: i hereby declare that the contents of this consignment are jly and eccuralely described above by the proper shipping name,and are classified,packaged, <br /> marked and labelediplacarded,and are in all respects 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 of this consignment conform to the terms of the attached EPAAcknowledgment of Consent <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a small quantity generator)is true. Month Day Year <br /> GQnerator's/0iferors Printedliyped Name S re f - "� �{ p If <br /> 16.intemational Shipments ❑Import to U.S. ❑Export from U.S. Port'of entry(exit: <br /> ~ Date leaving U.S.: <br /> F= Transporter signature(for exports only): <br /> W 17.TransporterAcknowledgment of Receipt of MaterialsLLJ Month D y Year <br /> Tra 'ter 1:P�ntte:dfy Name Signatua .�li/ F� tr-1SignatureMonth Day Year <br /> Z ransporter 2 ed[Typed Name <br /> :72- <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number. <br /> U.S.EPA ID Number <br /> 18b.Alternate Facility(or Generator) <br /> J <br /> U <br /> ua. Facility's Phone: Month Day Year <br /> LO 18c.Signature of Alternate Facility(or Generator) <br /> a <br /> Z <br /> S2 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> W1 <br /> 2D.Designated aality Owner or Operator.Certification of receipt of hazardous materials covered by the manifest a xcept as noted in Item i Ba Mon Y <br /> P ntedffy�d Name Signatu , <br /> EPA Form 8700-22 Rev_3-05) Pr `,vious editions are 4solete. _ DESIGNATED FACILfTYTO GENERATOR <br />