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SSL SK SHIP* 220606394 11111111 IN 111111111111111111111 <br /> 005523393SKS <br /> Please print or type.(Form designed for use on elite(12-pitctl)lypewrilec) FormApprroved.OMB No.205U039 <br /> UNIFORM NA2ARDOUS 1.Gearator ID Number 2.Page 1 of 3.��ency Ras roe Phone I.llanlfect n lander <br /> WASTE MANIFEST CALON397036 1 1-800-4�8-1760 1 5 5 Z um er 9 3 SKS <br /> 5.Gereretors Name and Mai'ng Address Cammlces Ska Address(it dilfererd kren wfi g address) <br /> FoDdliner <br /> 2467 E Mariposa Rd <br /> STOCKTON CA 95205-7893 <br /> Generaws Phone: 209-642-5020 <br /> 6 SR�ETY aL Ta1�SYSTEMS, INC. .EPA DNwto <br /> TXR000081205 <br /> 7.Trarspoder 2 Canpany Name U.S.EPA O Number <br /> 6.Desrproted Fedky Name and Site Address CLEAN HARBORS OF WILMINGTON LLC <br /> U.S.EPA ID Madder <br /> 1737 EAST DENNI STREET <br /> Facil s <br /> WILMINGTON , CA 90744 <br /> 310-835-9998 CAD044429835 <br /> Phone: <br /> 9e. U.S.DOT DesWpW PCWN Proper Shipping Name,Hazard Class,ID Nvnba. 10.conmilxs 11.Tdai 12 Unk <br /> HM and Padang GrauD(kamyl) No. Type ON" yytMI. 13.Wada Codes <br /> NON—RCRA HAZARDOUS WASTE, SOLID DM P 223 <br /> (OIL FILTERS) 1 <br /> w 1 V <br /> Z 2. <br /> w <br /> 3. <br /> d <br /> 14.Specoil HandTag Iwtuctions and AdMonaj hvanetim TSD:W I 71801358 F021051 CSG-. <br /> 24 HR El RGENCY #1-800-468-1760 (SK / TFI) <br /> AUTH15. OENERATOR'SOFFEROR'S CERTIFICATION:i hereby declare that the contends of this mnsiganenl are kAy and amsalely desaared above by kre proper shipping tame.and are destified,p8*49ad <br /> marked and Wel' 8—ded,and ere to all mWftls in proper C4)Ndm foraans0od amx*ig to appfmabiet nlematwnal and natlornl gd adrnentai <br /> mg ".".H e)pW shpmenl and 1 am kre Prbrery <br /> EVoda,I candy that the contents of trm corsignmers cordon to me tenors of Uro amavn d EPAAtlow7edgnem of Corsem. <br /> I certify that the waste minimization stateme t Wemified in 40 CFR 262.27(a)(it I am a large quantity genarabrl or(b)IMI am a small quay*generator)is ave. <br /> [resfOftroe3 <br /> Pmtsdayped SlgnaWre <br /> u� O rvn o Y ear <br /> —r 16.ImErratiaral Shi{mafns <br /> Ix <br /> 0 Oy11V <br /> F- ❑Import to U.S. ❑E artfrom Pat of emryfe or <br /> = Trorspater sigreare(kr exports ony): Date leavrg U.S.: --- <br /> cc 17.TranWorlwAdnm4edgmenlof Re o(ofMafeials <br /> o TrarspodNa— Sigram er 1 P*ted7Typed Na <br /> 1 �i Mwth Diary van <br /> H F� M0 00 <br /> Q lrpspDrw2 FrovediTyped Meme Mao Day Year <br /> K <br /> r <br /> 16.Diss MadcT <br /> 18a.Discrepancy IndcaUm Space ❑Quantity ❑Type ❑Residue ❑Partial Relemn ❑nl Rebdar <br /> lab.Ntemale Fadity(a Gart"or) Maldael Relerenw Number. <br /> U.B.EPA ID Number <br /> V <br /> 4 <br /> LL Fedklys Plane: <br /> w 18c.Signature ofAkanste FacilityGenerator)(or <br /> Q kbnriDay year <br /> z <br /> y19.NazaMous Waste Report Management WOW Codes lie,,colt for hazardous waste bahrwl.disposal,and recycling sydene) <br /> wn t 2. 3. 4. <br /> 20.0`50amd Fao9y Owner a Operator:Cartlfimtlon of recepl of herardous mantas eoversd by the manifest exzapt as noted m Item I9a <br /> arae MonM Dayea <br /> E '141T 3�1 1 ;evbuse 11 fsareebedete. DESIGNATED FACILITY TO DESTINATION STATE(IF REOUIRED) <br />