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71742 <br />_ J—......I t— I. naln 11 RK I.ww.urifar I <br />III IIIIIIIForm Approved. OMB No. 2050-W39 <br />IPr�IIIR Iin�lll�ll'II IIII <br />nacatr <br />0— v pya. t wm uoayuw <br />UNIFORM HAZA14000S <br />— — ..., ...w t r <br />I. Generator toNumber <br />GIL.tDQrt�28�7F 45 <br />2. P t of <br />3 E r e cY Res rise PT 7�� orte <br />"I� 4-I <br />4. MarJlest Tracking Nu r <br />002952770 SKS <br />WASTE MANIFEST <br />5. Gem aWs Name and Meiling Address Generators Site Address (d diftrent than meikng address) <br />RYDER T/S 1071 <br />3633 Duck Creek Dr j <br />Stockton CA 95215-7953 <br />Generator's Phone: 209-943-3218 i <br />s. � U S. EPA 10Nuntoe ) <br />_°e%�'�° SYSTEMS, l: nIC. TY R0td0050930 <br />U.S. EPA 10 Number <br />Name <br />7. Tl3iy5pouec2.6eagany I <br />D1�/J iC� SBe�7S , <br />J /zip n <br />8, Designated FacddyName and Site Address SAFETY-•KI.E_E:N SYSTk MS INC. ul DNumber <br />-6<011 <br />1722 COOPER CRU <br />DEN` ON, , TX 76208 <br />940-483--5200 TXD077603371 <br />! <br />FadGl 's Phone: <br />ga <br />9b. U.S. DOT Description (incming Proper Shipping Name, Hazard Class, ID Number, <br />10. Containers <br />f I. Total <br />12. Unit <br />13 Waste Codes ) <br />'. <br />No. <br />Type <br />HM <br />and Packing Group Of any)) <br />Ouenlily <br />WI.Nd. <br />• + �' : i <br />X <br />I RD UN2794 WAST -E BATTERIES, WET FILLED <br />WITH ACID (LEAD,SULFURIC ACI.D3, <br />DF <br />P <br />D402.. <br />DUN. <br />1111 j <br />L7UTS <br />s: <br />o <br />( <br />8, PG 111, (D002, 1)4108) <br />- <br />w <br />w <br />3. <br />4. <br />14. Spedal Handling lnsructions and Additional information 5K H I P#205905571 6742704 9526583 CSG % <br />1)1-.RG#154 <br />24 HR EM` AGENCY #1.-•800-468-1760 (..ri�i?t - LEEN - CONTRACT #`34138) <br />SK AUTH'D TO USE SUBSEQUENT CABBIE 5:41078 41 ' 8�'�' <br />15. GENERATOR'SIOFFEROR'S CERTIFICATION: 1 hereby declare that the contents of d is consigtrnent are fully and accurately described above by the proper shipping name, and are classified, packaged, <br />marked aril labeled/placarded, and are in all respects In proper condition for transport according to applicable Internatlonai and national governmental regulations. If export shipment and I am the Primary <br />Exporter, I certify Ural the contents cKtis consignment conform to the terms of the attached EPA Acknowledgment of Consent <br />I COW the waste iza I Identifie(Nn 40 CFR 262.27(a) Of I am a large quantity generator) or (b) (Ili am a sTal quantity generator is We. <br />Mon t <br />Signature th D5eary <br />Generator'n me <br />`` <br />ntarnal coal is Import to U.S. ❑ EzpoM1 from .S. Port clantrylaxll: <br />❑ <br />Z <br />Transporter signature (tor exports only): Date leaving U.S.: <br />W <br />17. Transporter Acknowiedgmenl of Receipt of Materials <br />q � <br />0. <br />'. <br />QTrans <br />2 PrnteNTyped Nams afore Moth Day Year <br />a <br />Lt nJ ti <br />- <br />i8. Disuepancy <br />( � <br />18a. D,uraoancy It•iGCHlkxt Space ❑ pr ar tity ❑ Type ❑ Residue LJ Partial RojedfGr. ❑ Fu! Rejection <br />Manifest Reference Number: <br />18t. Alternate Facility (or Generato) U.S. EPA ID Number <br />U <br />Faditys Phone: Month Day Year <br />,d <br />18c. Signature of Aitemate Fac&y (or Generator) <br />- <br />z <br />19. Hazardous Waste port Management Method Codes (,e., codes for hazardous waste treatment, disposal, and recycling systems) <br />3. 4. <br />Des gnalod Fecddy Owner or 0'\pejrat : Certiticalim of receipt of hazardous materials covered by ibe !est except as ntled In Item 18a <br />--Year <br />Pr 1 T Name lalwe ITM, I pay <br />7 .. <br />(D a <br />ry r CcTrRi ATir-im CTATG /IG ❑C11111RF111 <br />EPA Form 8700-22(R1111 1 Pre'nouseditionsyr�ibsolele ucZ>IUNAtcu rAUIL 1 r 1 <br />1 ) 11-002031112. U <br />9t' <br />