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714':' <br /> Please print or type.(Form designed for use on elite(12 pitch)typewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS I.Generator ID Number CAI-00016-316,i 2.PagE I1 of 3.�meraarlcY Rpspgnse Pho7n0e It 4.TbTr�ld mer <br /> WASTE MANIFEST �JJttttvy 9DDttii 16 S SKS <br /> 5.Generator's Name and Mailing Address Generators Site Address(if different than mailing address) <br /> CENTRAL .CA KENWORTH <br /> 10998 S HARLAN RD <br /> F'RENC14 CAMP CA 9S231-960C, <br /> Generalo sPfwne: 209--983-6970 <br /> 6.Tt�psoorler7�(, MLkt SYSTEMS, INC. U.S.EPA ID Number TkR0000 50930 <br /> 7.Transsp000rtterl2 Company Name U.S.EPA ID Number <br /> B.Designated Facility Name and Site Address SAFETY-KLEEN SYSTENSr INC. U.7ffBIpNumber <br /> 6000 88TH STREET <br /> SAC.RAMENTQ CA 95828 CaOQOrJU04517 <br /> 916-386-4913 <br /> Facility s Phone: •. . <br /> 9a 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes <br /> HM and Packing Group(d any)) No. Type Quantity Wt.Ivol. <br /> X 1. WA;TE PAINT RELATED MATERIAL, 3, UN12'63, DM P D001 0018 D035 <br /> 46-- PG. IT, ' U (3039 0040 21, <br /> 2. <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional Information SI.( SHIP a , 50615524 9040990' 201018 CSG.-22 <br /> VER113#0.128; Uo77Qr`11. g <br /> 24 HR EMERGENCY #1-800-468-1766 (SAFETY--KLEEN — 941.38) <br /> SK.AUTHOkIZED TO RETAIN 4ICENSED SUBSEQUENT.CARRIERS AS NECESSARY <br /> 15. GENERATOR'SlOFFEROR'S CERTIFICATION:I hereby declare 1ha1 the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, <br /> marked and labeledlptacarded,and are in all respects in proper condition for transportaccording to applicable international and national governmental regulations.II export shipment and I am the Primary <br /> Exporter;I certify that the contents of Ihrs'oonslgnment conform to the terms of the attached EPAAcknowtedgmenl of Consent. <br /> I.cerUfy tfiatthe.yrasle mlhimlza'n statement idehlifed i 90 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a small duan' erierator)is true. <br /> GeneratoeslOtfe expyediTyped am) Signature Month p7Oay�, Year <br /> 16.International Shipments <br /> Import to U.S. ❑Export from U.S. Port of enlrylexit: <br /> Transporter stgnafuTe(for exports only): Dale leaving U.S.: <br /> 17.Transporter Acknowedgment of Receipt of Maienals <br /> LLJ <br /> E2'Transport rinled/Typ Name Signature Month Day Year <br /> -141 10 <br /> VOON <br /> Transpa er nfedrTyped Name Signature Month Day Year <br /> 18 Discrepancy <br /> 18a osaepanay Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J_ <br /> V <br /> Faciliys Phone' Month Day Year <br /> 18c.Signature of Alternate Facility(or Generator) <br /> .. <br /> �:1 ff.hazardous Waste Report Management Method Codes-(i.e.,cedes for hazardous waste treatment,disposal,and recycling systems) <br /> 2 . <br /> . _. - 3. <br /> 4 <br /> 20.D�isrgoaled F6cifilyOvvdr4r Operator:Certification of recei azardous materials covered by the manifest except as noted in Item 18a <br /> Printedy erne Signature Month Day Year <br /> EPA Form 8700-22(Rev.3-05 Previous dilionsareobsolete. DESIGNATED FACILITY TO GENERATOR STATE(IF REQUIRED). <br /> :1)12607/.15042 <br />