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7-185-01 <br /> Pause pftntar type. Form designed far use qn elft-(12-pitch)typewtitef.) Form roved.OMS No.2050.0039 <br /> UNIFORM HAZARDOUS I I•Gena'aW 10 Number 2 Page I of 3. nergeacy Response Phone ata est ran ng umbaarr (� c <br /> WASTE MANIFEST CAL000244818 0002/t0803 SKS <br /> - <br /> 5. <br /> `s'`.+ 4! ra <br /> 5.GanereblsNoraamdMa—lNAddress Gc ratoraSite Address Qfditentthan maingaddress) <br /> MONIER LIFETILE <br /> 342 ROTH ROAD AATN: FINANCE ADMIN <br /> LATHROP ' CA 95330 <br /> Generatoes Phone: 209-983-1600 <br /> 6.Trans ow 1 Cc an Name U.S,EPA tO Dkanbar <br /> SAFETY-KLTNN SYSTEMS, INC TXR000050930 <br /> 7.Transporter Y Company Name U.S.EPA ID Number <br /> 7Ui94 11:x0 fle / <br /> 8.Oe4gnaledFactily Nameand Site Mdress SAFETY-KLEEN SYSTEMS, INC. 000618 U.S.EPA ID Number <br /> - -- -'1722 COOPER CREEK ROAD - <br /> DENTON, _ TX 76208 <br /> 940-483-5200 TXD077603371 <br /> Faail es Phone: <br /> ga, 9b.U.S.DOT Dwx4tion Qndadmg Proper Shipping Name,Hazard Gass,ID Number, lo.Containers 11.Total 12.unit 13 Wash Codes <br /> HM aro Parkn9 Group Qf any)) No. Type Quantity WINd. <br /> a X WARDOUS WASTE LIQUID, N.O.S. DM .(/ P D006 D007 008 <br /> o DISTILLATION BOTTOMS)9 UN3082 PGIII- f <br /> ERG#l7l)(D006, D007, D008) 1 252 OUTS <br /> LIP <br /> ji 2. <br /> c7 <br /> 3. <br /> 1 — . <br /> 1If.SpecaiHandlmgk 1ruclimsandAddtnomafal4rm Con SK T #108279515 0001897089 <br /> SK AUTH'D TO USE WWOUENT CARRIERS:10343, il038. 81661 82739 86256 <br /> 15. GENERATOR'S/OFFEROWS CERTIFICATION:I hereby declare that the oontents of 11tH consignment are 1.:y and aazeataly described above by the proper shipping rwm.and are dasslied,packaged, <br /> marked arra labdedlptacatdcd.atiid are(ask respects h proper corrdimiom for UwmpodscoorTkka to apprrca5:: -,WuUW arta nationd 9ovemmsntal teourl6ons.U wpwt ship M and t am the Primary <br /> Exporter.I certily that fi>e contents of alis consignment conform to the terms of gne adadted EPAAcknowW,,,•:ma of Consent <br /> I eerily that the waste minknizaWn statement fdenbfied in 40 CFA 262.27(a)(if I am a targe quanat gerlwao:,,or(r)Qrfarn a small quantity generator)Is true. <br /> Genera s10f<erorsPAntedrTypedN5m® Signab.: Monde Day Year <br /> J 16.Intranational SNpraants <br /> i— ❑import 1.U.S. ❑Fspod from U.S. oN of errtylezrk <br /> ? Transporter signature(kr exports only—' Data leaving U.S.: — — <br /> W 17.TransporterAekncMedgmentofReciiplofMalaUs <br /> Transporter 1 PdntedRypedName Signatua• MmV Day Year <br /> '0Ir -- <br /> 7 <br /> Z¢ <br /> Transporter 2 Pdriedftyped Nares Signet�• Month Day Year <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑Quantity ❑Tw, LJ R.tdoe Q Partial Raiection Full ReJoetion <br /> 6imfest Reference Number. <br /> i6b.AltomaleFad6ty(orGer>arabr) U.S.EPA tONumMtr <br /> Z3 <br /> LIC FacilitysPhone; <br /> t8c.Signature of Apemale Facitity(or Gemeraior) Mori Day year <br /> Q <br /> Rl19.Hazardous Wasp Report Manage.rnenl Method Codes(i.e.,nodes kr twzerdous nasi~•treae^renl dsqCsal,am:: :cycling systems) <br /> G i. 2. 3, 4. <br /> Lbc I 1 <br /> 20.Oes;gnated Faal,ty Owrter or Qpentor.Cementation of racaipt of hazardous matedais c,4wO by the mar►fesl :.epi as rimed k gem lea <br /> PnN�d )v Ih Day Year <br /> PAFAr i C�y22{�e�v. <br /> 345f Previaus ttlyns ars obsolete. 4) DE.::GNATED FACII. TO DESTINATION STATE(IF REQUIRED) <br />