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7142" x. :: •._ <br />Please print or type. (Form designed for tate on elite (12 -pitch ewriter.) <br />UNIFORM HAZARDOUS 1. Generator ID Number . <br />WASTE MANIFEST CAL000049151 <br />5. Generator's Name and Matling Address <br />FIRESTONE -028746 <br />720 E. HAMMER LANE <br />STOCKTON CA 95210 <br />Generator's Phone: 209-951-2403 <br />6. Trans rter 1 Compan Name <br />SAMETY--KLZEN SYSTEMS, INC. <br />O025461053K5 <br />Form Approved. OMB No. 2050=0039 <br />>. Page 1 of 3. Emergency Response Phone4. Manifestr�rack ng Number <br />1 1-800-468-176 ► 0 0 2 5 9 610 5' SKS <br />TXR000050930 <br />US ECOLOGY NEVADA 11srD Number <br />11 MILES S OF BEATTY HWY 95 <br />800-239-3943 BEATTY ; NV 89003 <br />Facility's Phone: NVT330010000 <br />ga. 9b. U.S. DOT Description (induding Proper Shipping Name, Hazard Class, ID Number, 10. Containers 11. Total - 12. Unit <br />HM and Packing Group (If any)) 13. Waste Codes <br />No. Type Quantity WtNol. <br />0 1'NON RCRA HAZARDOUS WASTE, SOLID DMP- 352 <br />(WASIL AND(NOTTUSBOT HAZARDOUSBENT MATERIAL) ��� <br />to 2- NON—RCRA HAZARDOUS WASTE, LIQUID DM P 343 <br />i(BRAKE FLUID) <br />_.___...,a_.__—__..__.._.__..._.._............ SK SHIP#203663989 53715812 3399729 CSG: <br />I HR EMERGENCY #1-800--468-1760 (SAFETY—KLEEN — CONTRACT #94139) <br />GENERATOR'SIOFFEROR'S GERTIFB:ATION: I hereby dedare that the this CO&Ignment are fully and accurately described above by the proper shipping name, and are classified, packaged, <br />marked and labeled/placarded, 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 thatihe contents of this consignment conform to the teas of the attached EPA Admowledgmen( of Consent. <br />I certify, that the waste Minimization statement identified In 40 CFR 282.27(a) (d I aur a large quantity generator) or (b) (91 am a small quantity generator) !s <br />es/08eroes PrinteCyped Name $lg t Mq�th Day Y <br />t— U Import to U.S. LJ Export from U.S. Port of entry/exit: <br />? Transporter signature (for exports only): Date leaving U.S.: <br />17. TrensporterAdc-Medgment of Receapt of Materials <br />Transoftr 1 Prints oed Now <br />18. Discrepancy <br />18a. Discrepancy Indication Space Quantity ❑ Type <br />18b. Alternate. Facility (or Generator) <br />V <br />Facility's Phone: <br />18c. Signature of Altemate Facility (or Generator) <br />r,D <br />❑ Residue <br />rn 19. Hazardous Waste Report Management Method Codes (I.e., codes for hazardous we treatment, disposal, and recycling systems) <br />p 1 2. 3. <br />20, Designated Facility Owner or Operator. CerBflcation of receipt of hazardous materials covered by the manifest except as noted in Rem 18a <br />Printed/lyped Name Signature <br />EPA Form 8700-22 (Rev. 3.05) Previous editions are obsolete. DESIGNATED FACII <br />1)419302/18084 2)42056513576169 <br />❑ Parfial Rejection <br />U.S. EPA ID Number <br />4. <br />Day <br />❑ Full Rejection <br />(IF <br />