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7-185-01 <br /> Please print or type.(Form designed for use on elite(12-pitch)typewnter.) Fonn Approved.OMB No.205MO39 <br /> UNIFORM HAZARDOUS 1.Gen orator ID Number CALOQOZ4481t• 2Pageioff', FmergencyResponsePhone 4.tfianiteaatTrackingNumber <br /> WASTE MANIFEST 1 1-800-468-1760 000543670 SKS <br /> 5.Genoroloes Name and Mails Address ;orators Silo Address(A ddferent than ma ng address) <br /> MONIER LIFET�LE <br /> 342 ROTH ROAD AATN: FINALCE ADMIN <br /> LATHROP CA 95`10 <br /> Generators Ptwne: 209-903-1600 <br /> 6.TOffl?PffiggoSYSTEMS, INC U.S.EPAIDNunhber TXR000050930— <br /> 7.Trans odor Compary Name U.S.EPA M Number <br /> ;�;,1o >37F1 <br /> 8 Designated FacdayName Ind Silo Address I SAFETY-KLEEN S`•'STEMS, 71' 000618 US.EPAIONumber <br /> 1722 COOPER CRI.EX ROAD <br /> DENTON, TX 76208 <br /> 940-483-5200 TXD077603371 <br /> FacNlVs Phone. <br /> go. 90.U.S.DOT Deso;Won(IndurSng Propar Shipping Name.Hazard Class,ID Nu :.Vr. 10.Conlafners 11.Total 12.Unit 19 Waste Codes <br /> HM and Packing Group(d any)) No. Type Quantify WtNol. <br /> a XI• HAZARDOUS WASTE LIQUID, N.O.S. DM P DOOf DO01 D00 <br /> o DISTILLATION BOTTOMS)9 UN3082 P0.11 <br /> ERG#171)(DOO6, D007, DO08) 252 OUT <br /> z 2 <br /> uj <br /> 0 <br /> 3 <br /> 4. <br /> 14 $peCral Handling InsWcUOrhs and Additional► 6on SK TRMW6*-1 <br /> 95�� 0)01891 08V <br /> SK AUTH'D TO USE SUBSEQUENT CARRIERS: 10343,41( :3,81681,82739,86256 <br /> 15. GENERATORVOFFEROWS CERTIFICATION:1 hereby declare stat the conteas::f this oonsignment• • ,.ay and accu alely described above by rte proper stopping name,and ate classdied,packaged, <br /> marked and Iabaledlpiacaroed,and are in at respects in props`corAuon for tfanspc i according to apps ,international and national gwtammental regulaWns.it 9W4 shipment and I am the Primary <br /> Evoner,I e Aty that the contents of this mnTgnmeni conterm to the tames of the vached EPAAduo wnt ofCSru-WL <br /> I cerll y that the waste mininhaWn statement identified In 40 CFR 282.27(W)(if I ar a large quantity gcr:,• .:r)or*M)(gl sm a smay quantity generator)is kue. <br /> GOnaratofVUffera'sPrvltedfTypodName S'. a Mamh Day War <br /> A. lei <br /> � t6 lrttema a <br /> Shiprar <br /> Import b U.S. ❑e-;;frac: Port of ealryfoxit <br /> Transporter slgnature fforexporis only). Date leaving U.S.: <br /> 17.Transporlorgdohwuladgrnemof Rocs pt of Materta)s <br /> Tran5 Name Si•7.• e Month Day Year <br /> C rr r' a <br /> o . ) : , t 1 <br /> Z Traruporler2 note ypad <br /> W Sc% a <br /> 4 <br /> e 00, OVA <br /> 18.Dmerepancy -— <br /> 18a.Drsrrepanq Indeaeon Space ❑ flaanwy ❑T;i., ❑Residue ❑Par"Rejection ❑Fug RejhhNan <br /> Manifest Reference Numther, <br /> 18b.Aitemale FacAly(or Gong") _ U.S.EPA ID Number <br /> U <br /> L%. Faraatys Phare: <br /> w T8a Signature o(Altemaw Facd-ty(or Generator) Morhth Day Year <br /> y19.HqarquLVWSRepori!t!nagament Metras Codes(Ie.,modes forhazarrfous acs ucafinent,dfspo> J revWng system;) <br /> UU <br /> LU 1. N 1; I 2. 1 7_-1 <br /> 20 D ed oro Owner or Qperal :Cenificaton of receipt or bazardhws malwc s•ovwod by the Ina rxcept tied h Item 18a <br /> Pmhl MW- IV,,( -( �••: .:e /' r. <br /> Y-M-lt�j <br /> E 1)00037N,m8100- R 2)�5) previous editiprys are obsolete. 4) .•..;dGI�IATED FAGILI'TYTO S A N STATE F R E ) <br />