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6 set print or type.(Farm designed for use on elite(12-pitch)typewriter) <br /> Form Approved:OMB No:2050-0039 <br /> ' UNIFORM HAZARDOUS I.Generamr ID Number 2.Page 1 of 3.Emergenq Response Phone d.Manifest Tracking Number r <br /> WASTE MANIFEST CALOOP310240 - _ —Il _ 001509533 <br /> n i C O(]C <br /> YJ1J JJ SKS��' <br /> S.Gerrenarols Name and Mailing Address Generamfs Site Address(if different Nan mailing address) <br /> MCLANE FOODS <br /> 800 EAST PESCADERO DR <br /> TRACY - CA 95304 <br /> Generators Pigne: 209-221-7514 <br /> 6.Trzns rter I Co n Name U.S.EPA ID Number <br /> SAFETY-)M SYSTEMS, INC. TXR000050930 <br /> 7.Tmrepbder2Company Name U.S.EPA ID Number ' <br /> 8.Denigrated Fadtity Name and Site Address SAFETY-KLEEN SYSTEMS, INC, 000618 US.EPA ID Number <br /> 1722 COOPER CREEK ROAD <br /> Fackrys Phone. DENTON, TX 76208 <br /> 940-483-5200 TXD077603371 <br /> ga. 911 U.S.DOT Desviption(including Proper Shipping Name,Hazard Class,ID Number, ID.Containers 11.Total 12.Uric <br /> HM and Packirxg Group(dany)) U.Waste Codes <br /> NO Tvp Guantity WLVol. <br /> NON <br /> (USED COILRA jHAZARDOUS WASTE LIQUIDS L' O� 16C p 221 051 <br /> z z. <br /> w <br /> 3 <br /> d <br /> 1<.Speaalhandling Instructions and sadnlanainformal SK TRCK$109905373 0003274117 <br /> SK U - 0 USE- SUBSEQUENT CARBIERS,41078- 4147 - - - -- - - — - <br /> 99 <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION; I hereby dedare Mat the contents of this consignment am fully and aaumety desalbed shove by me proper shipping name,am are d-lls d,packaged, <br /> marled and Iabeledlplacorded,and ween all respects in tamper coodil for manspod according to applicable international and national governmental regulations.It expert Shipment and I am has Pnmpy, <br /> Exporter,I ca0y,brat the contents of pis consgnment conform to the terms of me Watched EPAAcknavfedgmenl of Consent \ <br /> I onsfy that me waste minimization Wear enl identified in 40 CFR 262 27(a)(if I am a Large quantity general or Ib)(if l am a small quantity ge tenxler)is Mue. <br /> G n¢eraWlslOrt 'nted/fypetl Name�\ ) L/ SgnaN Moprv�b D1a�y Year <br /> J 16.International Shipments <br /> ❑ <br /> I— Import to U.S. ❑Export from S. Pod o(entrylezd: <br /> Transporter signature der exports ontyl. Date leaving U.S.: <br /> W 17.Transporter Acknowledgment of Receipt of Materals <br /> Tra r 1 PnnledrTyped e Sgna yr6 M p� Year <br /> y fav£ m f1 <br /> QTransporter 2 Pnvted(fyped Name Sgnotur Month Day Year <br /> k/, W LY <br /> 18.Discrepancy <br /> life.Disaepanry Indication Space ❑ Cuwny ❑Type ❑Residueej j <br /> ❑Penial R ection ❑Futl Rejection <br /> a - Manifest Reference Number <br /> Its,Ntemale Facility(or Genera l U.S.EPA ID Number <br /> J <br /> U <br /> LL Fwxslys Phone: I ( ( A� , <br /> w 18c.Sg^aeve of Alternate Fadlity(or Generator) '\.'. Month Day Year <br /> r <br /> Q <br /> Z <br /> w <br /> 19.Hazardous Waste Report Management Method Codes g Is.codes for hazardous waste Veabni disposal,and recyding systems) <br /> 2. 3. d. <br /> 20.Designated Factory Omer w Operemr Certification ei receipt of ha kms materials covered by the man mail except as need In Item 18a <br /> Promea,ped Name signature <br /> r tuo ; A - <br /> �]EPA Form 8700-22(ftev.W5) Previous ecipons are obsolete. 4) DE NATED FAC I LITY TO G ENE RATOR STATE(IF REQUIRED) <br /> -�dR .AV.1467 1 . 10470.1889 <br />