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�C. 005f o". 0257 <br /> 7-185-01 - <br /> - Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMR No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Geremla ID Number' 2.Page 1 o1 3.Emergency Raspp Phone 1760 e.MmBestgqTrxryrykl NumEer -y �/ <br /> WASTE MANIFEST CAL000128476 -800- - ®®d6� M3 1 SKS <br /> 5.Generall Name and Mailing Address Generators Site Address IB different Nan nailing address) <br /> STOCKTON FURTHER PROCESSIN <br /> 1111 NAVY DRIVE ZACKY PARRS ATTN DA <br /> STOCKTON CA 95206 <br /> Geneatds Phrne: <br /> 209-948-0129 <br /> 6.T 1�,�mar��Name U.S.EPA ID Number <br /> SAPETY-KLEEN SYSTEMS, INC. TXR000050930 <br /> 7.Transpod_q2.CMpqry Nene U. A ID�JVV <br /> 8.Desgnated Fadfity Name and Sde Address SAFETY-KLEEN SYSTEMS, INC. 000618 U.S.EPA ID Number ' <br /> 1722 COOPER CREEK ROAD <br /> FadlBys(MimeDENTON, TX 76208 <br /> 940-483-5200 TXD077603371 <br /> ' <br /> ga. 9b.U.S.DOT Desaip6on(iidWing Proper Shipping Name,Hamm Class,ID Number. 10.Comainars 11.Taal 12.UM <br /> HM and Paclag Gmuy(dany)) No. Type Quantity WIAw. 13.Waste Caries <br /> X ''HAZARDOUS HASTE LIQUID, N.O.S. DII P D006 D007 D008 <br /> O (DISTILLATION BOTTONS)9 UN3082 PGIII <br /> NOW D007, DO08) 2r 252 OUTS <br /> z 2 <br /> 3. <br /> 4, <br /> l4.spedal)faMBng Nstructiae aMAdGIiorW Mtomation SK TACXU09253284 \827,9, 85399 <br /> 075675 <br /> 1)ERGp171 <br /> SK AUTH'D TO USE SUBSE &ENT CARRIERS: 41078 41471 81681 <br /> 15, GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby dedae Mal Me mnams of Nis mawmenl a e NM end acnarmi dewibed above by ere proper shipping name,and am dasiow.paGaged_ - <br /> marked and labeledlplacarded,and am m all respects M proper condition for transport aaading 0 applira6le inlmnationa and naboral govemrnemal mgNations.If exporl shipment and I am the Primary <br /> Exporter I cer*Mat Me ooments of this censtgnne^l conform mine termer of the aaaded EPAAdwMedgmmtaf Com ent. - <br /> I mr*Mat Me waste mramtrebcm statement identiSed in 40 CFR 262.27(x)(d I am a lager quantitygener."a @) am a FTO qwn <br /> GareraldssPrinmdR me ��� Siglalum Monty Day <br /> Year <br /> O� <br /> 16.Intemabc al SNpmenk- Cd r <br /> F ❑Import to U.S. ❑Eiw horn U.S. Pat of envy/exit <br /> = Tmnsporw r signature If.export ordy). Date lea a g U.S.: <br /> w 17.Trengpal�ergAdn�owedgment of RRel�ceipff oMaterials <br /> lx yTramp JName aWm MmM Day Year <br /> Q Transporter2 P?3ed%yled Name Dar avTV��eagr - <br /> .} 18.Disaepamy <br /> I Ba'Decamancy Wiabon Space ❑ Duamity ❑Type Residue ❑Portal Rejectdn ❑Full R*dion <br /> Mani esl Reference Number <br /> 166-AltEmme Facility(or Generator) U.S.EPA ID Hunter <br /> J_ <br /> V <br /> LL FadMys Plcne: <br /> W 18c.Signature of Altemate Facility(or Generals) Moth Day year <br /> zz <br /> N19.Hazardous Me Repan Managerrenl Method Codes pe,cedes lar hammoi s waste beahrerd.Gspasal,and raryclig systems) <br /> Q 1. 2. 3. -T- <br /> 20.Desigated FaaTM O a or Operator.Ced'diatibn of receipt of hmrdous materWs mvemM by Ne mandest except as MQeddin Item I,BBa�1 'T p PdnteMYPed Name ('- r ` �manne 0� ( 7 y y 7 <br /> J o <br /> EfjoFo aj (R v 3-05) Previoused ane elf. DESIGNATED FACILITYTO GENERATOR STATE(IF REQUIRED) <br /> l ) 4) 10340.1250 <br />