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• <br />0 <br />0 <br />7-185-131 <br />a'oncn ,,.m' r,r n,r,a IP rm dnsianed for use on elite 112•Ditchl Ivnewriler.) <br />0 <br />Form Anoraved_ OMR Nn Mr fixAlAn <br />EPA Form 8700• ov.3.05) Previous editions) are obsolete, V 4) -DESIGNATED FACTO DF I9ATION STATE t(i REQU�iI:D) <br />1)000584 2 v <br />1)2196380/369993-9216 <br />5 <br />1 Goneralor IC Number <br />CALfl0006 $ 97 2001924614 <br />2. Page 1 of 3. EmergonoyResponse Phone 14.-Manlfoet <br />1 1-boa-468-1760M,alSl''ng0Ad <br />Tracking Num r -F <br />SKS <br />5s 5 Ganaralors5ila,rdd(g3s(Efdllierontlhanmaillrgaddross) <br />MACARTHUR DRIV TRUCK SHOP/WAREHOUS <br />CA 95376 <br />Ganorator s Ph„one:,2109-833-3190 <br />6.Trarif L'11f—AL'Y SYSTEMS, INC. U.S. EPA ID Number _ <br />TXR000050930 <br />7. Transporter 2 Company Nama U.S. EPA 11) Number <br />DD vgmt PdWyNiiyameandSlieAddress SAFETY-KLEEN SYSTEMS, INC. 000618 U.S. EPA ID Number <br />1722 COOPER CREEK ROAD <br />DENTON, TX 76208 <br />940--483-5200 TXD077603371 <br />Facility's Phone: <br />ga <br />9b. U.S. DDT oescripiion (Inducing Proper Shipping Name, Hazard Class, iD Number, <br />10. Containers <br />11. TDlal <br />12. Unit <br />No. <br />Type <br />HM <br />and Packing Group (if aqy)) <br />ourarthly, <br />wilvel. <br />13, Wasto Codes <br />1 PQ WASTE PLAMMAIi LIQUIDS, N,O.S. <br />DM <br />P <br />DOC1 <br />DOOB DO1 <br />(GASOLINE) <br />_ <br />M213 <br />OUT <br />3 UN1993 PG II (D018,D001) <br />z <br />2. <br />w <br />c� <br />3. <br />4, <br />14.SpeciatHitWglnstiuclionsarwJAddionalInformation SVrRCK#110495439 0002862503 <br />SK AUTH'D TO USE SUBSEQUENT CARRIERS; 4103$ 87585 a168j. 62739, <br />16. GENERATOR'S10FFEROR'SCERTIFICATION, Ihonideclarethatlieconlenlsofthisconsignmentarefullyandaccuratelydoserbudabovebyfilepropershippingnerve,andareclassified,paciagod, <br />marked end labolod1ptacorded, and are In all respects In proper cond[Von for transport according to applicable htelnatlonal and national govommanlal regulations. If export shipment and I am the Primary <br />Exponor, I ce0 that the contents of 'his consignment conform to the terms of fho atiarhad EPAAcknowledgri of Consent. <br />I certify that the waste minimization slalament idenlifNd In 40 CFR 26217(a) (91 am a iarge quantity genorslm) or (b) (111 am a small qu tily generator) is true. <br />Ga relo sf ff <br />o Prinladliypa oma Signature Month oey Yoar <br />od <br />16 InTomaiiOnalrallpmunis ❑Imporlt.U.S.7 <br />Expod from U.S. Porto ont !exit <br />= <br />Transporter signalure (for e)*odsonly): DatefeavingU.S.: <br />17. Tiansporlerkcknmvledgmanl of Receipt or Materials ddZi <br />Transprler1PuntedfrypedName � % Signalur Month Day year <br />Cs L <br />R <br />U) <br />Transport., 2 Pnnle yped Nims Slgnat re r moatfi Day Year <br />16.0iscrepancy <br />1Us. DiscregoncylydlcatlonSprce ❑ O mnlity ❑Type ❑Rasldae ❑PaNalRe�l <br />joalion �>'upRe}ec9ion <br />Manifest Reference Number: <br />16b. Alternate Facilify (or Ganerelo') U.S. EPA tlD Number <br />U <br />a <br />Fadlity's Ptwne; <br />lu SignalureofAJlemaleracarlyloTwillfri Month Day Your <br />a <br />Z <br />N19, <br />Hazardous vvnoeReport Msnag.menlMe'hodCodes (f.e„ codas for hazardous waste treatment, disposal, and rocyaiingsystoms) <br />LU <br />1. � <br />2. <br />3. <br />4. <br />20. Des[gneted fa a Of Opam ; Cattfwliuu ui roc 'pl of hazardous rnalerials cavilled by the rnantfes{ a i In Item <br />PrintedlTypad N e Sig ora c Ih DayI A&�' <br />EPA Form 8700• ov.3.05) Previous editions) are obsolete, V 4) -DESIGNATED FACTO DF I9ATION STATE t(i REQU�iI:D) <br />1)000584 2 v <br />1)2196380/369993-9216 <br />