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---� OWN— ---- -- --t 1111 <br /> - <br /> MO%print or pe.(Form designedfor use on elite(12-01ch)typewriter.) Form Approved.OMB No.2050.0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number - 2.Page 1 or 3.L.. --gency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST CAL000244818 001783508 JJ <br /> 5 .Generators Name and Mailing Addressasks Site Address CddiBemni IhRn mai4ng addrasel <br /> MONIER LIFETILE <br /> 342 ROTH ROAD AATN: FINANCE ADMIN <br /> LATHROP CA 95330 <br /> Generaws Phone:209-983-1660 <br /> 6.Transporter 1 Calrpan Name U.S.EPAU Number <br /> SAFETY-KI-EF SYSTEMS, INC TXR000050930 <br /> 7.Transporter 2 Company Nam U.S. ber - <br /> B.Oosgn edFapStyrta Addreu SAFETY-KLEEN SYS7`�:MSINC. 000618 U.S.EPAI Number <br /> 1722 COOPER CREEK ROAD <br /> Farafiry's Phone: D£NTON, TX 76208 <br /> 940-483-5200 TXD077603371 <br /> ga. 9b.U.S.DOTOese iplo(inckrdhg Proper S'b*Fpkg Name,Hazard Class,ID Num:- 10-Coniahers 1t.Total 12.Unit 13 Waste Codes <br /> NM and Paddrng GrotV(darny)) No. Type O asWty WUVot. <br /> oa X DISTILLATIONTBOTTOMS)9 UN14.3082 PGIII DM � P D006 007 008 <br /> SR0171)(DOO6, DO07, DOW O t'6/So 252 DUTS DO <br /> 2: 2. <br /> w <br /> c� <br /> 3 <br /> 4 <br /> t4.SpeoattiasadtigginsWcliottsaMM6aonffifntocmationSK 0776>588 0001897089 <br /> 15. GENERATOR'StOFFEROR'SCERTIFICATICK.1343,tTt33R ..;y <br /> hereby declare That the contents o!!'.s cwtsigriment are Iv and acaaataly desclrbed above bye*proper shippkg no,and are classified,packaged, <br /> marked and labaWptacarded,and are in an respects in properwridition for transport:>xonAng to app>katii,r'ematbnalaod rational governmental regulations.N export shipment and I am the Pdmaty <br /> Exports,I certify that the cmiiirts of this oa>stgnrnont cocriorm b IN larmsof the ana-.,ui EPAA&wwledg,-.."I of Canserd. <br /> I teritty that the waste mhimiratkxt statement klentSed M 40 GFR 26Z.2T(a}(d f am a:�o q'sarltity genas��;^a @}('dI am a stnatl ouantity generale)k true. • <br /> Gcneralo st aror's PrinledrrypedJame Sgnatuf Month Day Year <br /> V0-43t�f<�C•Z r Ins 4'� C3 <br /> .J 16, term onai Shipments �t <br /> 40, <br /> r ❑14'r?to US. t.J Fxport hem U.S. Pont of enirl exit: - <br /> Transporterslgnature(forexportsonty}: . - Data learisgU.S.: <br /> 17.TrarupxWAcknowladgW9 of Recap!ofMaterias <br /> Transporter 1 PrinkWyped Name Signalu,- j ` Month Day ear <br /> —�-�.. / /olet lac <br /> zQ Transporter Print Name S,gna,::• Modh Day Year <br /> 18. panrp <br /> 18a.thscrepancy Indication Space ❑ O.roxy ❑Typo "j Residue ❑Partial R*d, ❑Full Rejection <br /> tannest Reference Number: <br /> 18b Allemate Facility(or Generator) U.S.EPA ID NUmbe( <br /> V _ <br /> FacMtys Phone: <br /> W Signature ofAtkmate Faality(or Generator) Day Year <br /> Q <br /> z <br /> 19.Hazardous Waste Report lAanagementMeh)d Codes(s.,codes for hazardous was a r:atment,dsposat a,:;:•.yclitg systems} <br /> C2 1. 2. J. 4. <br /> 20.Desk}naadFacTtyOvnerorOp-cir8lor.Gedir-bonofrec¢iptofhaza�dousmatettatsu :r�y(br0temaniss+. -atastotedinvemlb <br /> T <br /> 7�7 <br /> - - $g 4•` Day Year <br /> EPA Form 8700.22(Rev.3-0 Prrivtotis editions are obsolete. np, 41 Ares,ee r++r r+..+•+ —••••_.-_. ._ <br />