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7-185-U1 <br />. 1� , .' <br />Please print or tvpe. (Form designed for use on elite 0 Ab) typewriter.) <br />Irl <br />F, <br />L <br />F, <br />L <br />4 <br />a <br />Form Approved. OMB No. 2050-0039 <br />1. Generator —MNumber 2. Page 1 of <br />UNIFORM HAZARDOUS <br />CAL00006897M <br />3. Emergency Response one <br />4. Manifest Tracking Number <br />SKS <br />WASTE MANIFEST <br />. Generators Name and Mailing Address Generators Site Address i different than mailing address) <br />5. c <br />ORCHARD H/S 0"55 <br />"HOP/WhREHOUS <br />'6650 NORTH MAI -ARTHUR DRIV TRUCK <br />TRACY CA 95376 <br />Generators Phone: <br />6. Transporter 1 Company Name U.S. EPA ID Number <br />SAFETY-VLEEN SYSTEMS, INC. <br />7. Transporter 2 Company Name U.S. EPA 1D Number <br />S.EPA ID Number <br />8. Designated Facility Name and Site Address SAFETY-KLEEN SYSTEKS, 114C. 00061S U. <br />1122 COOPER CREEK ROAD <br />DENT014, TX ?6208 <br />940 -4B" -C200 TX11'77603371 <br />Facill Phone: <br />9a. <br />9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, <br />10. Containers <br />11. Total <br />12. Unit <br />13. Waste Codes <br />No. <br />Type <br />HM <br />and Packing Group (if any)) <br />Quantity <br />Wt.Nol. <br />RQ WASTE FLi-.;HMABLE LIQUIN, 14,0-S. <br />D11 <br />P <br />lif <br />I DON <br />f" 0 1 <br />0 <br />I GASOLINE) <br />111- <br />9 <br />1� <br />3 UN1993 PG il (D018,D001) <br />--) <- <br />2. <br />LU <br />3. <br />4. <br />14. Special Handling Instructions and Additional Information0002882503 <br />Sk TRCK#110495439 <br />I )ERG1128 <br />JITH'I) To 11�`F "ARPTF P'� 4 10 1A 8,758S A I i�A <br />15. GENERATOR'S/OFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately desrrIl above It proper's'hlbi and are classified, packaged, <br />marked and labeled/placarded, and are in ail reSPECtS in proper condition for transport according to applicable intemational and national govemmental regulations. If export shipment 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 di in 40 CFR 262.27(a) (if I am a large quantity generator) or (b) (if I am a small quantity generator) is true. <br />G.nLrator'slDfleror's Printed/Typed Name Signature Month Day Year <br />—J <br />ii <br />16. International Shipments <br />0 import to U.S. ❑ Export from U.S. Port of ni <br />Transporter signature (for exports only); Date leaving U.S.: <br />LW17. <br />Li <br />Transporter Acknowledgment of Receipt of Materials <br />Transporter I PrintedfTyped Name Signature Month Day Year <br />0 <br />CL <br />ya <br />ZEn <br />Transports 2 Print ffaped Name Signature Monti Day' Yei IT <br />18. Discrepancy <br />18a, Discrepancy Indication Space ❑ Quantity ❑ Type ❑ Residue ❑ Partial Rejection ❑ Full Rejection <br />Man"Iest Reference Number: <br />16b. Alternate Facility (or Generator) U.S. EPA ID Number <br />Facility's Phone: <br />C3 <br />LL, <br />16c. Signature ofAftemate Facility (or Generator) <br />i Day Year <br />V5 <br />ig. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) <br />-T- <br />. <br />2. 1 3. <br />20. Designated Facility Owner or Operator: Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br />Printedi Name Signature Month Day Year <br />EPA Form 8700-22 (Rev. 3-05) Previous edil are obsolete. GENERATOR'S INITIAL COPY <br />0005646 2) <br />1)2196380/369498-9218 <br />