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low <br />SSL SK SHIP# 215725615 <br />F <br />or type. Form designed for use ❑n elite (12 pitch) typewrites <br />1. Generator ID Number 2. Page11 at <br />RM HAZARDOUS CAL�b$�76412 <br />STE MANIFEST <br />erator's Name and Malling Address <br />cneilus TruesAttn: Ral h Cortez <br />100 N Ad Art Rd CA 95815-2218 <br />tpcMtpnatvr'sPhone: �09-931^4282 <br />6. eHOH MM SYSTEMS, 1NC- <br />8.DesignatedFaciliyNameandSiteAddress CLEAN HARBORS BUTTONWILLOW, LLC <br />2500 LOKERN ROAD CA 93206 <br />BUTTONWILLOW + <br />561-762-6200 <br />Facility's Phone: 16. Contalners <br />ZPR <br />98 Ob. U.S. DDT Description (including Proper Shipping Name, Hazard Class, ID Number, <br />HM and Packing Group (H any)) ffrM <br />0 1){ZARDOU <br />ABSI]RBENTAMATER1ALDOUS wA(FLOORTE CDRYShND <br />Q PADS)) <br />flO4764216SKS <br />Form Approved. DMB No. 2050-0039 <br />4. Manifest Traakirg Number <br />004754216 SKS <br />TXR000081205 <br />U.S. EPA ID Number <br />CAD980675276 <br />11. Total 12, Unit 13. Waste Codes <br />Quantity Wt Nal. <br />P 352 <br />+4. <br />AUG 0 2015 <br />ENVIRON SEN <br />�.-rpj r1C0I0-r%A 'lliT <br />TSD <br />66511054 MC22499 CSS; <br />R. Special Handling Instrudmns and Additional Infmmatlon .HL <br />TEMM <br />ME36ENCY #1-800--468-1760 (SAFETY-KLEEN) <br />I! CC ORIZED TCI RETRIN LICENSlrD SU88EQt1ENTCARRIERS AS NECESSARYand labeo�lpiaca tled and are al Dyes I hermby oeclaco Uon for tn�sport according toapplirabla international ndnwrit are fully and lyna"nal governbod nmental negulati°e by the rns. a xport shWirqtshipmentand I am the Primary <br />pacts D Poertify thaithe conte Sa Df This consignment conform to the terns oftthan tlached Eua rycknovuee gment of or b C f i a° a small guanUty generator) is we.t the waste nrnimization slaiemant lderdifiied in 40 LFR 262.27(a) [ � q ()(Mon1h Day Year <br />signaiura "�d� �I { �� 11S <br />roi's PrintedlTYPed Name _ - r <br />V61nlema'onalSh'Ipmonts❑Exportfro�tiU.S. Part eentrylexit: <br />❑ ImporttD U.S. Date leaving U.S.: <br />_ansporter sigaatur° (tor exports only): <br />17.TransporterAckrxm edgmentiI eceiplolMalerials Month Day <br />Signatur <br />Transpo�erlPdntedffypedName I � 3 a� <br />18. Disuepancy ❑ FuIV Rejection <br />16a. Nrrepancy Indication Space ❑ Quaniity �TYP. <br />❑ Resdue ❑ Partial, Rejection - <br />Manifest Referenrre Number. <br />U.S. EPA [D Number <br />16b. Aitematn Fac liiy (a Generator) <br />J <br />U <br />rai Faaliys Phone. Month 1 Day <br />z <br />S2h9. Hazardous Waste Report Management Melbod Codes (i.e, codes far hazardous waste lrratment, d sposal, and recyGfig systems)4 <br />G 1. 2. <br />4132, e <br />20. Designated Facility Owneror operator. Cedifica4on of receipt of Hazardous materals covered by the manifest Month Day Year <br />re 1�Printedllyped Na -me <br />�/]�, C•�-✓A E CILITYTO DESTINATION STATE (IF REQUIRED) <br />EPl (3QIIl]7Q4'`editions <br />f 4s are obsolete. Page 1 <br />