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Please print or type. (Form designed for use on elite h) typewriter.) 0 Form Approved. OMB No. 2G50.0039 <br />UNIFORM KAZAkDOUS 1. Generator ID Number, 2. Page 1 of 3. Emergency Response Phone 14. Manifest Tracking Number <br />WASTE MANIFEST AL 00,006 8 9 7 r%, 11N <br />)01031A+',2'18 SKS <br />5. Generator's Name and Mailing Address Generator's Site Address (if different than mating address) <br />)PCHARL H/S 05555 <br />,650 NOPTH MACARTHUR DRIV TRUCK SHOPMAREHOUS <br />TFACY CA 95376 <br />Generators Phone: o09-833-3190 1 <br />6. Trans der lCom any Name U.S EPA ID Number <br />SAFVTY-�MVEN '�'YSTEMIS, INC. TXR00005093G <br />7. Transporter 2 Company Name U.S. EPA ID Number <br />8. Designated Facility Name and Site Address �ArETY-VLECN SYSTEMS, INC. 0006i8 U.S. EPA ID Number <br />1-722 COOPER CREEK POAP <br />DENTON, TX 76208 <br />Facility's Phone: 940-481-5200 1 TXV07769MI <br />qa. 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Containers 11. Total 12. Unit 13. Waste Codes <br />HM and Packing Group (if any)) No Type Quantity Wt.No <br />X 'RQ WASTE FLAMMABLE LIQUIDS, N. U. S. r.tti P, DOOIlDO08 Dolt <br />(GASOLINE) <br />3 u11!93 PG 11 (DOI�3,Dooi; <br />23.3 OUTS <br />2 <br />LU <br />3. <br />4. <br />14. Special Handling Instructions and Additional Jnfornnalon SK TRICKIii0e.4432667 0002882503 <br />'�'Y AIM" U, T" E S V E, EQ U E 14 T CA R R I E P, S 410-18. 4 14`11. 8168 1 8,2`7 5.65399 <br />Al- IT <br />1 GENE 4 <br />P <br />5. GENERATOR'S/OFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fu#Iy and accurately described above by the proper shipping name, and are classified, packaged, <br />marked <br />arked and labelediplacarded, and are in 0 respects in proper condition for transport according to applicable international and national governmental regulations. If export shipment and I am the Primary <br />a <br />Exporter, I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. <br />I_tf t� <br />I certify that the waste minimization statement identified 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 />Ge�net e JQf <br />ratoes1011feroes PrintedlTyped Name Signature Month Day Year <br />�-J 16. International Shipments <br />El import to U.S. ElExport from U.S. Port of entry/exit: <br />Transporter signature (for exports only): Date leaving U.S.: <br />LM17. Transporter Acknowledgment of Receipt of Materials <br />LJ <br />Transporter 1 Pnnted/Typed Name- Signature Month Day Year <br />CL <br />0 <br />A-4za <br />M Transporter 2 PdntffTyped Name Signature Month Day 'Yebr <br />18. Discrepancy <br />18a. Discrepancy Indication Spare EJ Quantity ❑Type ❑ Residue ❑Partial Rejection ❑Full Rejection <br />Manifest Reference NumbEr: <br />18b. Alternate Facility (or Generator) U.S. EPA ID Number <br />Facifty's Phone: <br />L <br />LU 18c. Signature of Alternate Facility (or Generator)7th Day Year <br />--1 <br />19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) <br />r. 1 3. -- 1 4. <br />20. Designated Facility Owner or Operator. Codification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br />Printed/Typed Name Signature Month Day Year <br />EPA Form 8700-22 (Rev. 3-05) Previous editions are obsolete. GENERATOR'S INITIAL COPY <br />10005646 2) <br />1) 27.96360/ 3>394% 8- I <br />