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i <br />SSL <br />lepltrlt ortype <br />SK SHIP# 214064441 �„� <br />L)D4�2 S3ti5K�V <br />e1 � Idn" <br />aSe <br />roln UmN wu syl uau U11 mw It luny r mw,. <br />UNIFORM HAZARDOUS 1, Generator ID Number . CALOOO276412 2, Page11 _ � 0 422530 AS <br />WASTE MANIFEST <br />5.cIr±Habra N�me and Mating A�arass Generators Site Address (if di8erarnt than mAV. addrea4) <br />ACneilus Truck <br />3102 N Ad Art ltd Attn: Ralph Cortez <br />Stockton CA 15-2218 <br />209 931--4282 <br />Genewbr's Phone: <br />s.Tr�o# imgarsM SYSTEMS, INC. S IDNranber TXR 108E . <br />7.T arter2CompanyNoma < U.B.ung <br />fir+! ✓ L Sar ccs C- 1 0.3 9 <br />8,Designated acility Name and Site Address CLEAN HARB[]RS BUTTON�3ILLOW, 'LLC U.S. IDNuminer <br />MN LOK <br />BUTT(INWi� <br />661--762--6200 CADW67 76 - <br />F a Phone: <br />ga <br />9b. U.S. DOT Description (including PwW Shipping Name, Haiard Clew, ID Number, <br />10. Containers <br />11. total <br />12. Unit <br />19.1A�Bte : s;t <br />No. <br />Type <br />HM <br />and Packing Group (iany!) <br />Qua" <br />1M_Nbi.. <br />NON RCRA HAZARDOUS WASTE SOLIDS <br />(ABSORBENT MATERIAL (FLOOR DRY N17 <br />DM <br />A`-�`� <br />P <br />352 <br />PADS)) <br />2. <br />3. <br />AUG <br />0 7 2615 <br />4. <br />E <br />A <br />NME <br />TAS. <br />17 <br />14. Spedal HatKbg Instructions end k1ditional AdditionalInformation TSD -.BL 6476$294 W22499 CS[3 t< ! <br />24 HR EMERGENCY #I—M@-468-171611 (SAFETYLKLEEN) <br />SK AUTHORIZED TO RETAIN LICENSED SUBSEQUENT CARRIERS AS NECESSARY , <br />15. GENERA7OR'3WFWW8 CERTIFICATIO1111:1 hereby dedare thatthe wants of this consignment are" and aac+aately deurtbed above by the proper sf long name, end are d"t", pa PIL <br />marked and latleledlplacarded, and aro in of reWads In proper can&9el4wjwsportaeoord1ng to appkable intemeb"wd natiarw governmental w4alans, ffexW shipment ON laid @tei?litraty <br />Expor*, I certify that the Contents of this wnslgnment conform to the cerins of the attached EPAWd OWedgment of Oonaea <br />I ceriiiy Thal jhe waste minimization statement Identf8ed in 40 CFR 292.27(a) (U I am a large quantity genevetar) or (b) (d 1 am a small quandty generator) 11 his. <br />Ge slOflerors Prtn%Wyped Nam* re i 'air <br />-J <br />16.IMematb menta i <br />El Import b U.S. ❑ E>�Crt from U.S. rt of entrylaxit — <br />Transporter signatue (for exports only . Date leaving U.S.: <br />17. TramsWnt of tacelpt � Mat811a1som <br />a <br />Aw <br />T r 1 PM*OTW Name <br />O <br />141 1 a <br />7 r e ,� rgnaimoe _ <br />18. Discrepancy <br />1 Be. Discrepancy Wpwtion Space ❑ Oueaty ❑ Type ❑ Residua Peet Rejection ❑ Frdi R <br />MatrlfMRehyw ca Number: <br />18b. Altemab Fadlliy (or Generator) U.S. EPA ID Number <br />t� <br />!.L <br />FaclVa Phone: <br />W <br />18c. ignature of Alternate Fa ty (or Generator) ear <br />' <br />a <br />C9 <br />19. Hazardous Pats Report Management tAefW Codes (Le., codas fa hazardous waste treatment, disposal, and recydkV systema) <br />C3 <br />1 lllf�' z 3. 4. <br />20. Designated F or Operator. Ce6ca0w of re* hazetdous maWats Covered by the manliest wnapt as n*d in Sem 18a <br />n e rmatvemom <br />ti' r V rf a tfultRwalu UU*wV10. GV —W.— <br />Page <br />i •v r/�v���a�+. .�/r� �. �, t.. .. .•...w� <br />Page 25r" ; <br />aw.l <br />