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Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.ONCE No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Pac:1 o` 3.Emergency Response Phone 4.Manifest Trac Number <br /> WASTE MANIFEST CHL 00032556 2 0 1`jg�7 6 5 �� <br /> 1 1-800-468-.1760 �JJ 11 <br /> 5.Generators Name and Mating Address Generators Site Address(if different than mailing address) <br /> ZH TECHNOLOGIES <br /> I.OiO SHAW RD <br /> STOCKTO14 :A 95215 <br /> Generators Phone: 209-547-1465 <br /> 6.Transporter 1 CoLnpav Name U.S.EPA ID Number <br /> TXR000050930 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address SAFETY_KLEEW SYSTEMS, INC. 0006.18 U.S.EPA ID Number <br /> 1"22 ::DOPER CREEK ROAD <br /> EN^t Oil, TX '76 208 <br /> 940-483-5203TXD0775v'3371 <br /> Faclli 's Phone, <br /> ga gb.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12,Unit <br /> HM and Paddng Group(if any)) No. Type Quantity Wl.Nto3.Waste Codes <br /> K 'HAZARDOiis WASTE LIQUID, N.O.S. DM P D006 DG07 D008 <br /> o ( DISTILLATION DOTTOMS)9 UN3062 PGIII <br /> (DO06, D007, D008) 2 JtJ 252 OUTS <br /> U.1 2- <br /> W <br /> � 44 <br /> 4 <br /> 3. I t <br /> I = <br /> f <br /> I <br /> 4. I <br /> 14:SpedaFHandlingfnstme9ons and AdditionaNafo—tion----K--?g <br /> :R AUPH'D TO USE SUBSEQUENT CARRIERS-.41078, 41471,81681,81'739,85399 <br /> 15- GENERATOR'SIOFFEROR'S CERTIFICATION:I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, <br /> marked and labelediplacarded,and are in all respects In proper condition for transport according to applicable intemational and national governmental 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 identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(f I a mall quantity generator)is true. <br /> Gepset0r0fieror s Pdnted/iyped t�aa a Signa Month Day Year <br /> �/ r � <br /> U��isi,,i. �• %' - �' <br /> 16.Ihtemational Shipments <br /> I- C Import to U.S. Expo. from U.S. Port of entry/exit: <br /> Z Transporter signature(for exports only): Date leaving U.S.: <br /> 17.Transpo knowiedgment of Receipt of Materials <br /> C) T arp*rter 1 Printed yped Name d )✓- ;Srgnatu Month Day Year <br /> za Transp r 2 Printed/Typed Name ! Signature Month Day Year <br /> F- <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space !__l Quantity ❑T e ❑Residue rr't1 <br /> Type ❑Partial Rejection LJ Full Rejection <br /> y.. <br /> Manifest Reference Number. <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> U <br /> tE FacilitysPhone: , <br /> UJ 18c.Signature of Altemate Facility(or Generator) Month Day Year <br /> Q <br /> z <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> LLI 0 1. - 11 M(.0 1 2. 3. j 4. <br /> 2011)esi Facility Owner or Operator Certificatian of receipt of hazardous materials covered by the man, excep(as noted in.Item 18e <br /> Pfinjearyped <br /> Naante r 7� } Si trne ! / %l / Month •Day Year <br /> EPf!g (N 2(�ev.3-05) Previous a tions are obsolete. i �J DESIGNATED FACILITY TO GENERATOR <br />