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SSL SK SHIP# 228243225 e , Please print or type. Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3. me ga y R s�pp�se P, E 4. Manifest Tracking Number SKS(� WASTE MANIFEST I;AI_000152�825 1 V KS 5.Generators Name and Mailing Address Generator's Site Address(if different than mailing address) 3C Trucking Inc 1415 W. Anderson St. STOCKTON CA 95205-0000 Generators Phone: 209-466--3282 6.TrgAp)$et_1,-Cp7?LtVR SYSTEMS INC U.S.EPA ID Number T,X F 000081 7.Transporter��2��ComltpSianny Name U.S.EPA ID Number CLEAN HARBORS ENVIRONMENTAL SVC INC. MAD0 39322'250 8.Designated Facility Name and Site Address CLEAN HARBORS ARAGONITE, I_1.0 U.S.EPA ID Number 11600 NORTH APTUS ROAD ARA6[lN I TE , UT 8402' 435-884-8100UTD9815 177 Facility's Phone: 9a. 9b.U.S.DOT Description(including Proper Shipping Name.Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes HM and Packing Group(if any)) No. Type Quantity Wt.lvol. X 1' I Yui 141 '. 0 L X 2. UN18231,14ASTE SODIUM HYDROXIDE, SOLID, � TP P D0112112 141 81 PG .:� 3' LIN1 323 WASTE SODIUM HYDROXIDE, SOLID, P D1302 141 8, PG X 4. IIN I R30g WASTE METHANOL, 3, PG 11 DM ? P U154 212 14.Special Handling Instructions and Additional Information TSD t qB 79814127 3C 10836 CS(3.- 1)ERG#)154.2)ERG#154R3)ERG#154;4)ERS#131; 24H iEMERMNCY#800 4&8-17Et0•-CH/SK/TEI-Contract retained by generator confers agency authori y on initial transporter to add or substitute additional transporters on ener• tor' ha 15. GENERATORWOFFEROR'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, marked and labeled/placarded,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 Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a small quantity generator)is true. GeneratorslOfferors Printed/Typed Name Signature Month Day Year • . � • _ � �,' ' � r�ice.! � F 16.International Shipments ❑Import to U.S. ❑Export from U.S. Port of entry/exit: ? Transporter signature(for exports only): Date leaving U.S.: W 17.Transporter Acknowledgment of Receipt of MaterialsLU -� t- Transporter 1 Printed/Tf'ped Name Signature,. 4 f Month Day Year ZTransporter 2 `nted/Typed Name Signature �' Month Day Year H J 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Typej j ❑Residue ❑Partial Rejection Full Re ection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number J U LL Facility's Phone: w 18c.Signature of Alternate Facility(or Generator) Month Day Year Q Z N19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) G 1. 2. 3. 4. 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Printed(fyped Name Signature Month Day Year EPAf)$873 fflc Y 1 �1 2editions 86009obsolete. 2/182' 981 3)86013912/1827981 4)86013996/1827957 GENERATOR'S INITIAL COPY