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SSL <br />DL� MrA - f <br />P3 7 <br />SK SHIP* 0JPAA04ik4 <br />0 <br />Form Aomoved. OMS No <br />ase <br />V !=. -- - &,WWAM Trockhig Number <br />i. Gene"r ID Number ffW;W <br />UNIFORM HAZARE)DUSI IPYA -4 T. <br />10042116 <br />WASTE MANIFEST . I CAL0()0-L*7G"WL .127TOPE -SK <br />5. GeneraWa Name Ord Malting AM— Generators SMV6-esa ddlerenl lhan malllr@ address) <br />Y(&Akr1v-5 <br />�en��sl�i'orfa"A,1� <br />U.S. 11) Number <br />12Mi2RMWSYSTE"KS, INC. TX <br />7. Transporter 2 Company Name ul. EPA ID Number <br />& Designated Fatuity Name and Sr*Arldrm CLEAN HARBORS BUTTONW I LLOW, LLC U.S. EPA ID Number <br />2M LOKERN ROAD <br />BUTTOWILLOW CA 932% <br />661-762-6233 <br />FadrA es Phone: <br />ga. <br />9b. U.S. DOT DescAption Cinduding Proper Sft" Name, Hazard Clam, ID Nim9w, <br />16, CordainerO <br />11. Total' <br />Quantify <br />' 72. Unit <br />WLIM. <br />Codes' <br />HM <br />and PacWn9Group (1f8q)) <br />No: <br />Ty" <br />NoN —L NoN—RCRA HAZARDMS. WASTE, SOLIDS <br />--E <br />f <br />DN <br />q 00 <br />P <br />to* <br />LLI <br />Z <br />LU <br />RE <br />EI <br />'. 11 <br />AU <br />0 7 2%5 <br />4. <br />ENV! <br />ONMEMTAI <br />70 <br />r')COAOT <br />AVRI- <br />14. Special Handling Instructions and Additional Information. TSD:BL <br />1. <br />24 —KLEEN) 1HR EMEMUCY 01—NO-4M-17fill (SWETY <br />CaORTERS AS WJZMRY -177- <br />RMORIZED TO RETAIN LIMM 51AWAMI <br />is. GMRAr0RS0FM0Fr8CERTlFMA7M: I hereby declare W1 the contewft 01 this consignment ane W and uodurift dasobed above by ft:::::*N <br />It=marked and labe(ed/placarded, and are h all respects h pmW condition for eansport a=r&g to applicaNe InwnatioWand national 9mmmantal <br />EqwW, I artily that be oDntents of this 00091imeW conform to the term 01% adadicid EMAdmoviledgmerA01Consent <br />t o@rWy that the waste mbihizatIm statementidartfified In Q CFR 262 27(a) (K I am a largo qwntty generator) of (b)'(61 alien a amd qua" gueralor) is his. <br />1W MORM D w <br />K&roes PrintsdiTyped N pature <br />Ganeptors�7tz7/-Z <br />X C� <br />6. International SKpments EIIMPOIMU.S. <br />Transporter si�jnkn (for exports only): tsar leaving U.5.. <br />17.TtanspobrAdmoMedgmMofReoWdMaterials <br />Tran" I Printeffyped Nam* ignatJ Mor19r.:My <br />Okg:�4 <br />- Signature FAorM S year <br />18. Discrepancy <br />18a, Discrepancy hdication Space El Over* Elva D Partial Rejadon El Ft -i R*Z" <br />Manlfsst qg§Mce Number. <br />18b. Nbarrkft Facility (or Generator) U.S. EPA ID Number <br />CJ <br />rai <br />S= Xternate Facility (or Ganara" Month ° Year <br />19. Hazardous 4J Report Management Method Codm Cte., codes for )hazardous waste tretmK dspow,and M&Ycling VfitqMs) <br />2. 3. <br />12p. <br />DesJhated F afty Owners .-CerlfficaUon of recolpt of haze us materlals wmred by the manifagwooptas octad to Item 18a <br />7rintediTyped 1Nam nature 41 <br />LPA"P%K1 OVA'M "C OCIr'IfIl Wk <br />Pag'b'24 <br />