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�' 7-185-01 <br /> P <br /> Please print or type.(Form designed for use on elite(12-pitch)typewriter) Form Approved.OMB No.20500039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4. antrest Tracking Number <br /> WASTE MANIFEST CAL000244818 1000727966 SKS <br /> 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) <br /> MONIER LIFETILE <br /> 342 ROTH ROAD AATN: FINANCE ADMIN <br /> LATHROP CA 95330 <br /> Generators Ptrone: 209-983-1600 <br /> 5.Transporter 1 Company Name U.S.EPA ID Number <br /> SAFETY—KLEEN SYSTEMS, INC. TXR000050930 <br /> 7.Transpofw-2 mpany Name U.S.EPA ID Number <br /> 7/44# n1wo 1 010 <br /> 8.Designated Fadity Name and Site Address SAFETY—KLEEN SYSTEMS, INC. 000618 U.S.EPA ID Number <br /> 1722 COOPER CREEK ROAD <br /> DENTON, TX 76208 <br /> FacsiysPnone: 940-483-5200 TXD077603371 <br /> 9a. 9b.U.S.DOT Oescri flon(including ProperShipping Name,Hazard ans,)D Number, 10.Containers 11.Total 12.Unit 13 Waste Codes <br /> HV. and Packing Group(it any)) No. Type Quantity WII <br /> 0 1NON RCRA HAZARDOUS WASTE LIQUIDS DM P 221 OUTS <br /> 9 (HYDRAULIC OIL) <br /> Zz. <br /> 3. <br /> 4. <br /> 14.5p OCal Handling Instructions and Additionalfntormetion SK TRCK 9133530 0001897089 <br /> RIfidl,A2239- 86 256 <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION:i hereby declare that the contents of this consignment are fully and acaxatetydescribed above by the proper shipping name,and are dassitied,packaged, <br /> marked and labeled/placarded,and are In all respects in proper condition for transport according to applicable Inia adarat and rational governmental regulations.If export shipment and f am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAeknowledgmeot of Consent. <br /> I cedity that the waste minimization atatemer4 identified in 40 CFR 26227(a)(if I am a large quantity generator)cr(b)(V I am a small quantity generator)is true. <br /> e reratoe, 'Otterors PrintedTyped Name nn 5 nature th Day <br /> Year <br /> V 1) vV 'f�ti C.A <br /> —r 16.internal nal Shipments El Import to U.S. LJ Export from U.S. Port exit <br /> Transporter signature(for ex r(s only): Date leaving U.S.: <br /> 17.TransporterAcknowledgment of Receipt of Materials <br /> OTran rTrials 1 S•' ��Dayyq Year <br /> (101 Zig <br /> CC/ <br /> Trois Prkrte yped Name S th Day Year <br /> s wC e <br /> 18.Discrepancy nn <br /> 18a.Discrepancy Indication Space n O.Gty ❑Type I Residue ❑Partial Raoc an l I Full Rejection <br /> I.'anifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA 10 Nwrdter <br /> J <br /> U <br /> sa+. Fadliys Phone: <br /> 1k.Signature ofAlternaleFacility(orGenerator} <br /> � Month pay Year <br /> z _ <br /> 19.Hazardous Waste Report Management Mothod Codes(i.e.,codes for hazardous waste heatmerd,disposal,and a...,Cling systems) <br /> p 1•t n I 2. 3. 4. <br /> 20.Designated FadfrPj Owner or tor:Certification of receipt of hazarddws materials covered by tie man'des , as noted in K <br /> Prinled/fyped Name Si ku .� o th y <br /> EPA Form 8700.22(Rev.3-05 revio editions are obsolete. DESIG NATED FACILITY TO DE STI STATE(IFR UIRED) <br /> 00187630 2) 3) 4) <br /> 1)200144204/40220018 <br />