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7-185-01 <br /> Piease print or ne. Form des4wd for use as ab 9 4mt toned OMB W.2QSQ t)Q39 <br /> UNIFORM HAZARDOUS 1,Generator t0 Number T.Pape tot 3.Ei,<'rp�Y Response Ptone r <br /> WASTE MANIFEST CALo0014481a -QQ=MA-126Q J 000M760 SKS <br /> S.GenerakXs Name and MAV Address Gen, .tors Sr1oAddiaa(ff ff reru ttmn naallnp W*_q t <br /> HOMIER LIFETILE <br /> 342 ROTH ROAD AATN: FINANCL ADMIN <br /> LATHROP CA 95330 <br /> Generators Poona: 209-983-1600 <br /> U.S. PA Number <br /> SAF TYrK Ar SYSTEMS, IHC. TXRO00050930 <br /> 7.Tra of 2 Company?�ame E Ip N <br /> —I Ell <br /> 8 DesrgnQ Fao*NarrwandReAddress SArETY-KLLEN SYSTEMS, INC. 000618 U.S.EPA IDNumbw <br /> 1722 COOPER CREEK ROAD <br /> DENTON, TX 76208 <br /> s4o-4a3-szao ?XD077603371 <br /> FactiK 's Phone: -r - .•.a.;r r <br /> ga. 9b.U.S.DOT Desatp W(h np Propw S**v Norm,Haaerd Class.lD Nur.:tax T0.Corxtairwre 11.Total 12.Unit 13.Waste Codes <br /> HM +9 pid ) No. Typo Qtrantily MAK <br /> X hASARDOUS WASTE LIQUID, X.O.S. DM P D006 007 008 <br /> DISTILLATION BOTT 14S)9 UN3062 PGIII <br /> 1 <br /> DISTILLATION <br /> D007, D0W / � 252 OUTS <br /> 2. <br /> c� <br /> 3. <br /> d. <br /> 4. elHandlrgtttstrudions SK TR 109(150916. 0001847089 <br /> 1)ERG#171 <br /> SK AUTH'D TO USE SU13SE UEIfT CAR Ta •s i 3 43036 .16a <br /> 15. GENQtAT0R'Sl0FFER0R'9 CE"FICAM9.I twroby dodm dW tlw cw*o r4 dde ca Wp owrd are fi:';:and axuu ly dasalbed abow by 1M Proper sMppkg narrm,rd are dassifled,pad"W. <br /> marked and tsbeWplacardd.and aro In all revects In proper wndr0on for'trwag t ao wdN to spokeble •,:mmriwww d natiorw g venwenlat repuwi m.M export*,Igg at s W I am ttw Pdmaq <br /> ExpMet.Ice*that the canter>d d ft oataignment contam loft lerms of the el.,dwd EPAAdmowW0g,:.d d Comixtt. <br /> l certify d*the waste mintmlratbn statement IdwAW to 40 CFR (e)Qtl am a q ty f7 @){QI rocs nnai psreerabr}'s tnea <br /> s! s P*Os*T Name Da), Year <br /> v <br /> 1 .Intematxonat ' - <br /> Import to U.S. ❑Ewl from U.S. Part d entrylexit <br /> Transporter signature(forexports ): 11- Dyad U.S <br /> a 17.TwWorwAdiovWknwgotReo*ofMaWriub w,'gI <br /> QTransport PriMedlfyped Na S <br /> Mf <br /> T 2 Printew r,. Y <br /> 18.Olsaepancf - <br /> 12 vu_ <br /> t 88.DisUepanGy rrrdreation Space <br /> 00—My OTY1, 'J R ❑Pordal Ra.b. ❑Fu1 Rajedion <br /> 18b A temaie Facility(or Gerwrator) U.S.EPA ID Nrmxber <br /> !,I Facility's Phone: olly <br /> x <br /> lBe S�tatvre of Attamate acikty(a ) c <br /> N 19.Hazardous Waste RepotMV498MO MOO Ccdea_p e.,codrotlarbszlgdputm, treArnsnt,disposal err yd M sydmtrrm) <br /> i. 2 3• <. <br /> __ / 4, -1 <br /> 20.Desi Fac+ItyownercrOper w drec*ofltsVJ tq tmndby0Wmen4etr. n*dia 18s <br /> .t pod Na+rw , <br /> AIIAcJ <br /> EPA orm 700.22((Rev, j Provwus edbons are obsdete. DEQ ;HATED F iL TO DES-n m 1014 STATE(IF RE{dviR ) <br /> 2)0003715 2) 3) 4) <br />