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7-185-01 <br /> Please print or type.(Form designed for use on elite(12•pitch)typewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator to Number2.Page 1 of 3.Emergency Response Phone 4.1-anifest Tracking Number <br /> WASTE MANIFEST CALOi�0148053 — — 100-1078105 SKS <br /> 5.Generator's Name and Mailing Address Generatols Site Address(if different than mailing address) �0 <br /> AUTOZONE # 5686 <br /> 1448 N EL DORADO <br /> STOCKTON CA 95202 <br /> Generator's Phone: 209-939-9132 <br /> 6,Transporter 1 Company Name U.S.EPA ID Number <br /> SAFETY—KLEEN SYSTEMS, INC. TXRO00050930 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address US ECOLOGY NEVADA 050505 U.S.EPA ID Number <br /> 11 MILES S OF BEATTY HWY <br /> BEATTY NV 89003 <br /> Facility's Phone. 775-553-2203 NUT 3 3 001000 0 <br /> 9a, 9b.U.S.DOT Description(Including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11,Total 12.Unit <br /> HM and Packing Group(if any)) 13.Waste Codes <br /> No. Type Quantity Wt.Nol. <br /> 0 1. NON RCRA HAZARDOUS WASTE,SOLID DM P 352 <br /> (ABSORBENT) <br /> Z 2. <br /> LU <br /> t� <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional information S K TRC K#109 7 8 28 2 0 0002881068 <br /> Sk AUTHORIZED TO RETAIN LICENSED 'RUB�RFQIJEN-T CARRTFPI.� C <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately 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 exportshipment and I am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. <br /> I certify that the waste minimization statement identified in 40 CFR 26227(a)(if I am a large quantity generator)or(b)(III am a small quantity generator)is true. <br /> G erator's(Offerofs Printedffyped Name Sig at Month D Ye <br /> L 6.International Shipments <br /> F— ❑Import to U.S. ❑Export from U.S. Port of entry(exil: <br /> Transporter signature(for exports only): Date leaving U.S.: <br /> 17,Transporter Acknowledgment of Receipt of Materials <br /> UJI <br /> Trans 1 Printed yped a Signature Month Day Ye <br /> a <br /> Transporter Printedffypetl Name rgnalure Month Day Year <br /> rX <br /> ti <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number. <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> V <br /> rQ+ Facility's Phone: <br /> 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> Q <br /> Z <br /> V519.Hazardous W sle Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 0 1. 2. 3. 4. <br /> �� <br /> 20.DesignaIpd Facilit ner or Operator:Certification of receipt of hazardous materials covered by the manifest exce 4 asfdejKr#em 18a <br /> Prinfe yp d Nam Signature o Ye <br /> EPA Folm 8O0-22( •05) Previous ellitions are obsolete. DEESI ,IV.T AGILITY TO DESTINATION STATE IF QUIR D) <br /> 1)0187699 2) 3) 4) <br /> 1).2182507/333549-409 <br />