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A <br />SSL SK Sty I 17865-.-r <br />11111111111111111111111 I11111 ii 11111 <br />Please print or type. (Porn designed for use an elite (12-01ch) writer.) <br />0 0 3 9 6 3 9 1 3 S K S <br />age <br />UNIFORM HAZARDOUS If-(3enerat0rlDNun&r 2. pall', <br />CAL000276412 1 <br />ncy Re a Phone <br />�—n �—� —176.0 <br />form Approved. OMS No. 2050-DD39 <br />4. Mani[est Tiackin Num <br />WASTE MANIFEST <br />0 0 3 9 6 3 913 S KS <br />5. CiVerattWs Name and Mailing Address <br />McneiIUS Truck <br />Ger eratols Site Address Cd cri fe" than mailing address} <br />3100 N Ad Art Rd Attn: Ralph Cortez <br />STOCKTON <br />CA .95215-2'218-. <br />c�eracatsP►wne,m._p�a_�2,����ja:_93i=�4��2 <br />fi V?ii "— Lt�JY SYSTEKS, INC. <br />U.S.EPA 0Nunher <br />TXR020081205 <br />7. Transporter 2 Company Name <br />U.S. EPA ID Number <br />S. Designated Faclity Mame and Ste Address CLEAN HARBORS €iRMON I TE <br />LLC <br />U.S. EPA fl) Number <br />11600 NORTH APTUS ROAD <br />ARAGONITE <br />435-884--8100 <br />, HJT 84029 <br />F s Phona: <br />UTD981552177 <br />ga. 9b. U.S. DOT DeStdption Cncluding Pmpar Shipping Name, Huard Glass, ID Nunta, <br />M. Containers <br />11. Total 12. Unit <br />12yftUr <br />HM and Pad&V Group Cff any)) <br />No. Type <br />13. Waste Codes <br />Qua" w. <br />1 <br />NONE NON RCRA HAZARDOUS WASTE SOLIDS. <br />r (COit1E1COB ABSORBENT, OIL), NIP <br />Di4 <br />P 352 <br />� <br />30& <br />AUG 9 7 20h5 r <br />_...n.� ... nii+aniijuvn TSD:A6 62415931 MC `22499 CSG: <br />3 <br />24 Hit F.IrIERGENGY #1-800-468-1760 (SAFETY—KLEEN) SURP337-7 <br />—SEE A11WAKENT <br />15. GENERATORSDFFEROR'S CERTIFICATION. I hereby dedero that the ocnfertts of tMs CMSOnent are fully and accuratety described above by the proper shipping name, and are dasslled, padiaged, <br />marked and tabeledfptacarded, and are In all respects In proper condition for transport acoor ft to epprrcable international and national garammm" regulations. If export ehl mem and I am the Primary <br />Exporter, I cer* that the contents of this consignment conform to the berms of the attached EPA Adalwhtedgntard of Consent <br />I OD* that the wash minhy lzation statement identified In 40 CFR 282.27(a) (if I am a targe quantity generator) or (b) CdI am e l quality genera is Ince. <br />Genera ppEMeroes "ne —'.K, a Swami I _ rle t hAnMh n- v.— <br />io. mwrrraoorner anrpments 11 <br />Ip°d o U.S. El Export irom U.S. Port a <br />Transporter sgatu a (for expoAonly}Date leaving Us,: <br />17. TransporterAckwMedgmentof Receipt ofMatedals <br />banePdn oma Signature klarm <br />Al 03 7 1 1 Zi o5av I /3 <br />31 <br />18. Discrepancy ( -. ��--77 - — <br />188. Discrepancy Ind'rntion Space 11 Quantity ❑Type ❑ Resl t,._.I Partial Rejection ❑ F.1 Rejection <br />18b. Alfemate Facilly (of Generator) Manifest Refererroe Number <br />U.S. EPA ID Number <br />v <br />a - <br />V- Faclt[yls Phone: <br />182, Signature of Altemate Facility (or Generator) trlontr Day <br />19. Hazardous Waste Report Msnagemerd Method Codes (i.e., codes for hazardous waste trratmant, disposal, and recycling systems) <br />LU n 1A l x f l -... 2. a141 <br />hazardous materials covered by ire manifest except as noted in item 18a <br />CrH r rt wed ors are obsolete. Q>=SIGl+IA71;6 1= L O bEs-nNATIOR ^aTRTE IF RE1JfgEQ <br />Page 15 --- <br />