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7142 <br />III 1111111111111111111111111 ill 111111 <br />Form Approved. OMB No. 2050-0039 <br />YIea58 <br />pons Of type. trait <br />UNIFORM HAZARDOUS <br />neu wr uae u mitc , c-Nn...r ,rr�a„w,. <br />1. Generator 0 Number <br />CAL00la28Ql645 <br />2. P tot <br />1 a nsa <br />iE"-1 <br />N. Manifest Tracks Num er <br />0 0 2 6 3 7 6 3 SKS <br />WASTE MANIFEST <br />5. Generators Name and Ma" Address Generators Site Address (if different than ma" address) <br />RYDER T/S 1071 <br />3633 DUCK CREEK DR <br />STOCKTON CA 95215-7953 <br />Ge.a,,, Prang: 209-943-3218 <br />U.. PA ID Nutrber <br />s. T�.�,c�e SYSTEMS, INC. T X R000050930 <br />7 Transports+ 2 Company Name U.S. EPA ID Number <br />d /c'd!-,)rJ �/ 5 t�'� 7T/ <br />8. Designated Facility Name and SkAddress FETY-KLEEN SYSTEMS INC. U14#tlD Nuneter <br />1722 COOPER CREEK ROhD <br />DENTON, + TX 76208 TXD077603371 <br />940-483-5200 <br />Fec�Ilys Phone: <br />9a <br />9b. U S. DOT Description (inckdng Proper Stepping Name, Hazard Class, ID Number, <br />to. Containers <br />11. Total <br />12- Unit <br />13. Waste Codes <br />NO. <br />Type <br />HM <br />and Packing Group (if any)) <br />Ouanbty <br />WINol. <br />y <br />t NON RCRA HAZARDOUS WASTE SOLID <br />DM <br />G <br />352 <br />OUTS <br />o <br />(ABSORBENT AND OIL) <br />J <br />�^ y <br />f <br />q <br />ll <br />LU <br />Z. <br />W <br />3. <br />4. <br />-T4—Sp ons and Additional InlormationSK r } 9501786 CSG: <br />2�s� z YY�J <br />24 HR EMERGENCY #1-800-468-176 (SAFETY—t: -- CONTRACT ##94138) <br />SIS AtJTH' D TO USE SUBSEQUENT CAR 8 41471 81681 82739-15399 <br />that the of this co msigrxnent are fully and accurately described above by the proper shipping name, and are classified, packaged, <br />15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare contents <br />marked and labeled/placarded, and are in all respects in proper condition for transport according to applicable international and national governmental regulations- Ir export shipment and I am the Primary <br />Exporter, I cattily that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. <br />.ty a) is true. <br />I cenity, that the viasle minfmlzation statement identified in 10 CFR 262.27(s) (if I am a large quantity ganerabr) or (b (if I am a small qu ge <br />Month Day Year <br />Ge rslOff s PrinWffyped Na / Sgnatur� <br />�, r(Z-It <br />/' C q <br />16. nMrneliamal SlepnneMs ❑Import to U.S. ❑ Export from .S. Port entry/exit.' - <br />Trasporter nly signature (for exports oi Oa leav ng U.S.: <br />n <br />17. Trans nor AcknoMedgment of Receipt of Materials <br />Month Days Year <br />Transports l'awedRYped Na/mei Signature . <br />O <br />a <br />c/i Y 1t <br />Signature Month Day Year <br />Z <br />a <br />Trans ai ? Prntod/iyped Name <br />/ y2 4 / <br />�il <br />t- <br />2 /— �r�,SIL <br />18. Discrepancy (�'1 <br />tea Olscrepancy Indication Space ❑ ❑ Type ❑ Residue Partial Resection ❑ Full Rejeckin <br />Ck;antdy <br />Manifest Reference Number <br />18b Alternate Facility (or Generator) U.S. EPA 10 Number <br />U <br />uQ- <br />faciklp'sPtwne: ktorstl Day Year <br />LUz <br />16C. Signawra of Alternate Facility (or Generator) <br />O <br />19 N.azardnxxns Waste Report Managenenl Method Ccdes (.e., codes for hazardous waste treatment, disposal, and recycling systems) <br />w <br />D <br />t� � <br />2 <br />3. <br />4 <br />26 Deslgnaled Facility Owner or Operata: Certification of receipt of hazardous materials covered by the mart I except as noted in Item 18a <br />Day air <br />P;ptodflyped N SgIloufe <br />nu r vn 11GC'rl IA rr1A1 QTATr 11P R tiff! l71 <br />EPA)F��B7-(1�ogpj '� Previousaditon�a,"bobsolete! UCDI1jIV/-IICU rr+x.rtar r , ���t...�., ,. -. a•• . <br />1 lr!aI,T6/1 f11 � <br />i <br />