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7142 <br />III 1111111111111111111111111111111111111111 <br />Form Arinroved. OMB No. 2050-0039 <br />rtease <br />pnrn yr type. trvrni uvwy <br />UNIFORM HAZARDOUS <br />mu wi - vi It 11- t -r^-„/ ,lr�••,,,�.r <br />1. Generator IU Number <br />CAL0002.8064S <br />ag lot <br />2. Pall <br />1 3 <br />4. Mumber <br />SKS <br />3763WASTE <br />MANIFEST <br />5. Generator's Name and Mailing Address Generators Site Address (If different than mailing address) <br />RYDER T/S 1071 a <br />3633 D CREEK DR.3TOCKTON <br />E"CEIVF <br />ON CA 95^c15-795 <br />Generator's Phone: 209-943-3218 <br />U.S.-CPAID Number <br />6.T -opai` is TXR000050930 <br />S(�aSYF <br />7. Transporter 2 Company NameU.S. EPA ID Number <br />NV' RONM o/�ep 571P-1 <br />8. Designated Facility Name and Site Address FETY-KLEEN SYSTEMS INC. 11ENT U:�, DNumber <br />1722 COOPER CREEK ROhD <br />DENTON, � 'TX 76208 TXD077GO3371 <br />940-483-5200 <br />Facility's Plrone: <br />ga <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 />WI.Nol. <br />y <br />1. NON RCRA HAZARDOUS WASTE SOLID <br />DM <br />P <br />35,2 <br />OUTS <br />o <br />(ABSORBENT AND OIL) <br />J <br />f <br />C7 <br />- <br />t4404 - <br />z <br />2. <br />- <br />w <br />3. <br />4. <br />14. Special Handling Instructions and Additional Information 1 r of 9301786 CSG: <br />2�s'7 2YY&) <br />24 FIR EMERGENCY W. -B00-468-1715 (SAFETY -K .- ' - CONTRACT #94138) <br />SK AUTH'D TO USE SUBSEQUENT CAR ' _ A 4147.1 A' L! r' 1 8c'- Ca �9 <br />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 />15. GENERATOR'SIOFFEROR'S <br />marked and labeledlplacarded, and are in all respects in proper condition for transport according to applicable international 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 EPAAcknowledgment of Consent. <br />I certify that the waste minimization statement identified in 40 CFR 262.27(x) (If I am a large quantity generator) or (b (if I am a small qua lily ge rator) is lrue. <br />Month Day Year <br />Ge or's/ON➢f6r's Printed/Typed Nai Signature <br />C �� / <br />16. demallonal Shipments ry <br />❑ Import to U.S. ❑ Expo t from .S. Port ant lexil: _ <br />2 <br />Transporter signature (for exports only): Dat leaving U.S <br />17,TranspoiterAcknowled ment of Receipt of Materials <br />Month Day._ <br />Transporie Prinled/Typed Name Signature <br />2CL. 3 1 <br />0 <br />t/-6.fv <br />Signature Month Day. Year <br />QTransp <br />erg Printed/Typed Name <br />%2. <br />��c✓nom c <br />18. Discrepancy <br />1 Ba. Discrepancy Indication Space ❑ Quantity ❑ Type ❑ Residue ❑ Partial Rejection ❑ Full Rejection <br />Manifest Reference Number: <br />U.S. EPA ID Number <br />181). Alternate Facility (or Generator) <br />v <br />ua <br />Facility's Phone: Month Day Year <br />LO <br />18c. Signature of Alternate Facility (or Generator) <br />Q <br />z <br />19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) <br />0 <br />1 T3. 4. <br />��acifityOwnerertification <br />of receipt of hazardous materials covered by the man t except as noted in Item 18a <br />Pni d/Typed Nae Sig ure ri nth Day <br />�... eTrr� ru r rn nt=cT1 A IC]N STAT fIF R UI d1 <br />ET. )F 06(JgFCIt .;1 ) rreviouseumonsaruuusurera: ���-•�^••, -- - <br />