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SSL 3K SMIPO 220686394 <br /> Please pent or type (Form designed for use on elite 12-pitch)typewriter.) <br /> Form Ap ved.OMB No.205G-009 <br /> UNIFORM HAZARDOUS 1.GeneratorID Number Tpa�1511of 3.E�e�py��n,cy Response Phone 4.Manifest racking burr <br /> WASTENANIFEST CALee0397036 1—DV0-468-1760 n 5 3 SKS <br /> 5.Generato s Name and Mailing Address Generatoes Site Address('d different than mailing address) <br /> Foodliner <br /> 2467 E Mariposa Rd <br /> STOIC CA 95285-7893 <br /> Generator's Phone: 209-642-502® <br /> 6.Transporter 1 Compan Neme U.S.EPA ID Number <br /> SAFETY—KLWN SYSTEMS, INC. TYR808881205 <br /> 7.Transporter 2 Company Name <br /> US EPA IG Number <br /> 8.Designated Facility Name and She Address CLEAN HARBORS OF WILMINGTON LLC O.S.EPA ID Numbe <br /> 1737 EAST DENNI STREET <br /> WILMINGTON , CA 90744 <br /> Faciliys Phone 318-835-9998 CAD844429835 <br /> ga. Bh.U.S.DOT Description('including Proper Shipping Name,Hazard Class,ID Number. 10.Containers 11.Total 12.Unit <br /> HM and Packing Group(if any)) No. Type Ouanl ry yyt,yci. 15.Waste Codes <br /> ' NON—RCRA HAZARDOUS WASTE, SOLID DM P 223 <br /> 0- (OIL FILTERS) ' { <br /> 145 <br /> W 2 I <br /> 3. <br /> 4. <br /> 14.Special Handing Instructions and Additional Information <br /> TSD:WI 71881358 F021051 <br /> cS68 <br /> 24 HR EMERGENCY 01.800-468-1760 (SK / TFI) <br /> r"':'NSEII 11111 <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: f hereby declare that the contents of this consignment are fully and accurately!ascribed above by bre proper ah pping+name,and are classified,packaged, <br /> marked and labeled/placarded,and are n all respects in proper condition for transport according to applicable international end national governmental regulations.If export shipment and I am the Primary <br /> Exporter,1 certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. <br /> I certify that the waste minimization statement identified In 40 CFR 262.27(a)(d I am a large quantity generator}or(b)(if I am a amall quantity generator)Is true. <br /> Generetw's/G6eroes Printed/Typed me <br /> Signature <br /> P4✓� :' �vim•v �_ � ron�th Day Year <br /> =u 16 International Shipments 1 v hir W, <br /> Z ❑Import to U.S. ❑Export hwn U . Port of entry/exit_ <br /> — signature(for acporis only): Date leaving U.S.: <br /> 17.Transpwisr-Acknowledgment of Receipt of Materials <br /> rxIWsporte•1 Prnted7Typed Name <br /> aO iii-J Signature Monti Day Year <br /> Z <br /> goner led(Typed a <br /> D I1 16 <br /> Q rVIENd Month Day Year <br /> 18,Disaapancy <br /> 18a.Discrepancy Indication Spaco ❑ Quantity ❑TyPe tiesidue ❑ <br /> ❑ Partial Rejection Rejection <br /> Mantfesl <br /> 18b.Alternate Reference Number:Facility(or Generator) U.S.EPA ID Number <br /> V <br /> LL Facility's Phone: <br /> LOU 18c.Signature of Alternate Facility(or Generator) <br /> ]�� Day Year1;N 2 , �did <br /> N19.Hazardous Waste Report Management Method Codes(i.e,codes for hazardous waste treatment,disposal,and recycling systems) <br /> D 1' I 2. 3- <br /> 4. <br /> 20.Designated FacAtty Owner or Operator:Ce0oabon of receipt of hazardous materials covered by the maniftipt except as noted in Item 16a <br /> Printed ype ff ame M1rtth p � r <br /> �LAir <br /> EPA Form 8700.22(Rev.3-05) Previous editions are obsolete. <br /> 1}7512803/156777 DESIGNATED FACILITY TO GENERATOR <br />