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714? <br /> Pleqse print or Type.(Form designed for use on elfte(1204LMW.) Font Approved.OMB No.2050-OW9 <br /> UNIFORM HAZARDOUS 1.Generstorl!)Number 1,f JEE 4.man Tracking Number <br /> -1 _ .1 . WIP <br /> WASTEMANIFEST t CAROW58073 .12, . I . :-1 <br /> 10,ItI'.- CI. <br /> a KS- <br /> S,Genorstoes Name MN <br /> Mal Aftess G aw sW A-e Address a a(ff different vent then milting a N n g a d am) <br /> TEICHERT MNOTRUCTI <br /> 120 Frank West Cir <br /> Stockton , CA 9Z5206-4eQ13 <br /> Gen erator'sPhone: VIC-825-8269 1 <br /> 'L"Y'—R&MffesysTw's, INC. U.S.EPA ID Number TXR60935030 <br /> 7.Transporter 2 Company-N—we U.S.EPA 15 Number .................. <br /> OL/I ZZ Zef <br /> B.l3e*naWFadN, Na=andSIteAddr9u '- SQFETY-KLEEN' SYSTEMS TNC I <br /> 1uoP <br /> 7?2 qF-P 6REEK R6AD 'MoNumber <br /> FOR(a Phone: 9411,-4 V3-5E10Qw DENTON, TX 76208 TH077603371 <br /> ga. 9b.U.S.DOT Dewiption(mcluding Proper Shipping Nam,Hazant Class,ID Number, 10.Containers 11.Total 12.Unit <br /> HM and Pacft Group(d any)) No. Type am" --Wtivd. 13,Waste Codes <br /> X 1-UNU6P 1Wp-,14RDOLK� I.( TE LIQUID. N.O.S. DN P Deck D007 DOM <br /> (D I ST 111 A.fION BO TOMS)' PO-111 <br /> 0606v M-7, NOS.) 01.37E <br /> z Z. <br /> W <br /> 3. <br /> 4. <br /> 14.$pedal ftWft Instrudons and gnat SK Sill R#P-06 175739 81 866,- a. yCSO C <br /> .3 <br /> I)ERS#171 ,- <br /> a4 HR FME-AGFNCY *1-800-468-1760 '(SAFETY-FLEEN - CONTRACT #9,43w <br /> SK AUTH'D TO USE SUBSEQUENT <br /> 16. CvBMATWSWFMWS CISIUMCK11ON: I hereby dedare thet She contents Of We am fully and accurately descrlbW above by the proper proper for shipping neme,and are classilled,packaged, <br /> marked and labeleolacarded,and am in all respects In condition tram rdI <br /> sport socong to apiplicable International and national governmental regulations.If wqpod shipment and I am the Primary <br /> Exporter,I cw*that the contents of this consigratod conform to the tenns of the attached EFAAdoumledlIrnent of Consent. <br /> I ce*that the waste minimization statement Identilled In 40 CFR 26227(a)(d I am a large quarft generator)or(b)(f I am a small quw*g@"*is he, <br /> GenerabrWKSI&S Pit me. re <br /> 47 „rte Year <br /> ❑Import to U.S. 0Export from U.S. Pat afentryle;dt'l-, <br /> Transporter silInature,(lbr exports only): Data feaft U.S.: <br /> 17.T of Receipt of Matmials <br /> T PrInWTyped N Z <br /> Month —Day Year <br /> J IIL <br /> Tw*Afm 2Prime Sill Moft Day Year <br /> net” <br /> n <br /> L4 Lf <br /> 18.Discrel -y <br /> 18a.Discrepancy Indication Space Quantity ❑Type EJ Residue El Partial R*&J,, El Full P*don <br /> Manifest Reforarve Number <br /> I Bb.Alternate FadIttv(or Generator) U.S.EPA ID Number <br /> tJ <br /> LL FadliVs Phow <br /> W Spature of Aftemate Facility or Generator) Month <br /> Day yes, <br /> 12,Hmmrdous Waste Report MamageffmA Method Codes(i.e.,codes for hmmrdous waste teatmenL disposal,and recycling systems) <br /> 1. 2. 4. <br /> 1 kk I --- . ........ <br /> 20,Des4nated Faclity Owner or Operator Certification of receipt of hazardous matedale covered by theme"except as noted In Item 18a <br /> FEW=yped Nam. �nabrre <br /> go—nth <br /> EPA FWffr0q.2? 05) Previous edltlons are obsolete. <br /> j"71 i DESIGNATED FACILITY TO GENERATOR <br />