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SK WHIR* 226599557 <br />Please print or. type. <br />Form Aooroved. OMB No. 2050-0039 <br />EP'4cU71W <br />ZA�%Ry,,j�;41 :7ievious editions ark pbsolele. DESIGNATED FACILITY TO GENERATOR <br />UNIFORM HAZARDOUS <br />1. Generator ID Number <br />_rwW Q�3�3 <br />2. P 1 of <br />3. m R _ <br />—� � <br />4. Manifest Track'JNu`]m�ber <br />Q 6 r 9 8 6 SKS <br />WASTE MANIFEST <br />O.i F t <br />5. GeneratVs Name and Mailing Address Generator's Site Address (if different than mailing address) <br />WBYr� I ir3'a521' <br />2700 S California St <br />SMCKTLN+t CA 95M, 000e <br />Generator's Phone: 209-373- <br />6. SYSTEMS INC U.S. EPA ID Number <br />7,' anW)rwr 2 Com n Namn U.S. EPA ID Number <br />MEAN FIt�R' k ENVIRONMENTAL SVC INC. �4Q1)039.3ar +`54t <br />8. Designated Facility Name and Site Address CLEANHARBORS OF SUTTONWI LLON U.S. EPA ID Number <br />255 LOKERN RnAD <br />BUTTIILLOW , CA 9322-, <br />INW <br />I -1 bre-6200 i'A�1rfltitd6 ; 5L 7t, <br />Facility's Phone: <br />go <br />9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, <br />10. Containers <br />11 Total <br />12. Unit <br />13. Waste Codes <br />No. <br />Type <br />HM <br />and Packing Group (if any)) <br />0 ,^' r'; <br />WLMI. <br />CZ <br />1. Nflt1s` NON RCRA HAZARDOUS WASTE LIQUIDS <br />DM <br />F° <br />5c' <br />!*t <br />(EWTY OIL CONTAINERS W/ RESIDUAL�ff <br />61L5), <br />2 <br />W <br />3. <br />4. <br />14. Special Handling Instructions and Additional Information TSD I BL 78057672 WE251s.`.� <br />24H EIIIERG NCY#8011-46&-1760--T:H/SK/TFI-Contr act retained by gelr�• <br />neator confers al trey author' <br />on initial trans o-te:- to ilii riv, substitute additional trans .. 1,-'• on eneratorls behalf. <br />15 GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name, and are classified, packaged, <br />marked and labeledtplacarded, and are in all respects in proper condition for transport according to applicable international and national governmental regulations. If export shipment and I am the Primary <br />Exporter, I certify that the contents of this consignment conform to rhe terms of the attached EPAAdKnMedgment of ConsenJ__ <br />I certify that the waste minimization statement Identified in 40 CFR 262.27(a) (if I am a large quantity generator) ai r) [fl am a small quanttt geperglarJis true. <br />GeneratodslOfferoes Pri,L'+ :yped Name sign at0re Month Day Year <br />5 <br />- <br />F <br />` -- - <br />16. 1hernaftnthl Ship e senuykzi <br />Import to U.S. ❑ Export from U.S. Port of _ <br />? <br />Transporter s r alure (for exports only): Date Ieavingttt$.: <br />17. Transporter Acknowledgment of Receipt of Materials _ - <br />Tra portor 1 Pr'nlqMyped Name Sigr*fe, r' Mont) Day Ic <br />a. <br />y 1 <br />Signature Month Day Year <br />Tomme; Name <br />18. Discrepancy r <br />18a. Discrepancy Indication Space❑ ffy <br />Ouant El Type El Residue ❑Partial Rejection Fun Rejection <br />Manifest Reference Number: <br />18b. Alternate Facility (orGenerator) U.S. EPA ID Number <br />J <br />U <br />uQ. <br />Facility's Phone: <br />W <br />18c. Signature of Alternate Facility (or Generator) <br />Month Day Year <br />a <br />Z <br />N19. <br />Hazardous ste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) <br />0 <br />1. <br />2. <br />3. <br />4. <br />20. besignated Facility Owr eralor: Certification of receipt of hazar s materials covered by the manifest except as noted in Item taa <br />Printed/Typed Mame 3 j Signature Mrth Day Year, <br />EP'4cU71W <br />ZA�%Ry,,j�;41 :7ievious editions ark pbsolele. DESIGNATED FACILITY TO GENERATOR <br />