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�;;. -..1111!!111 <br /> 387915-18 QI�0199U92PSHUlIUIl11H1lffIH)ilftIC " "3342470-001 <br /> Please print ar_fype,.( orm designed for use on elite(12-pitch)typewriter.) Form Approved,OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1 Ganeraor tO Number 2:Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST CAL00010240 1 (877)577-2669 001996292 PSC <br /> 5 Generators Nameand Mailing Address Generators Site Address(if different than malling address) <br /> MCLANE FOOD SERVICE MCLANE FOOD SERVICE <br /> 800 PESCADERO 800 PESCADERO AVENUE <br /> TRACY,CA 95304(209)221-7541 TRACY,CA 95304 2092217541 <br /> Generators Phow <br /> Transporter I Company Name €J.S EPA ID Number <br /> STERICYCLE SPECIALTY WASTE SOLUTIONS INC MNS000110924 <br /> F8.� <br /> ;ransporler 2 o pany Name ij EPA IO Number <br /> jb <br /> esignated Facility Name and ite Address1.5.EPA;p Number <br /> YUMAYES,LLC AZROOOSIS924 <br /> 2730 E.13th Street, <br /> Yuma AZ 85385 <br /> Facility's Phone: <br /> ga, 9b,tf S.OUT Eescnpti n(in€uding Proper Shipping Name.Hazard Mass.lO Number, 10.Containers 11.Total 12.!)rit <br /> HM and Packing Group(if any)) 13 Waste Codes <br /> Nu Type f)uanGty Nt;'Vgl <br /> Q t <br /> i <br /> W 2, NON•RCRA HAZARDOUS WASTE,LIOUID(DETERGENT,BRAKE FLUID) ? 1 <br /> a3 <br /> t CF 1,000 P <br /> f <br /> f <br /> J <br /> S <br /> Pe $ r <br /> t <br /> 1 <br /> t t <br /> 14,Special Handling Instructions and Additional Information <br /> L(2)MPNONHAZ.05-ERG(}MPNONHAZ•05-NON HAZARDOUS MATERIAL <br /> 15 GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby decfare that the conlents of this consignment are fully aad accurately described above by the proper shipping name,and are classified,packaged, <br /> marked and labeledipiacarded,and are in all respects in proper roodilion IV transport according to applicable international and national governmental regulations,it export shiprneirl and f am the Primary <br /> Expurter,i certify that the contents of this consignment conform to the terms of die attached EPAAcknowiedgment of Conserv_ <br /> certihy that the waste ri nimization statement identified in 48 CFR 262 27(a)(if!am a large quantity generator)or(b)(if I am a small quantity generator)is!rue <br /> .^era#ors. er s AnntedTimad Name ...rgna ur�+� Month Day Year <br /> -1 16-tilematio nal 10 8 18 <br /> Shipments �r�—[t <br /> I_u rrporl to U-S. Export from U S Port of entryfexit: <br /> Transporter signature for exports only) Gate Ieavirt U.S- <br /> U 17'ransporter Acknowtedgr int of Receipt of Matenafs <br /> Transporter.Prinued7yped Name, Mcqnaturf i <br /> Ponin <br /> ay ear <br /> a Andy Winkler 10 8 18 <br /> Q Tr fkyped rg onM Day Year <br /> CC ! <br /> IS Disorppancy <br /> 183,Discrepancy Indication Spare El Quantity �� <br /> l.�f Type �Residue E]Pallial Re;eciior �.i Full Releiilon <br /> Manifast Reference Number. <br /> 15b.Alternate Facility for Generator) L13 EPA IO Numbez <br /> J <br /> U <br /> Q <br /> ts. Faci1!t's Phune <br /> w 1&.Sgrature of Alternate FacilitY(or Generator) ,'+loath Day Year <br /> d <br /> Z <br /> a19.Hazardous Waste Report Managemert Method Codes(i.e.,codes for hazardous waste Ireatmanl,disporai,and m;yt'ri;systems) <br /> 2 <br /> 21 Designated F !ity Owner or Operator Certification of receipt of hazardous materials covered by the manifest ex)eNs noted in item 1 Ba <br /> Printedtfyped y e Sgnatu M- th Day, Year <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. <br /> oil 11111111 <br /> r ra lion r 0 . , <br />