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11/25/2015 WED 11!21 FAX 2098704468 SerViCeAdminMFD <br />f(�009/Ola <br />SSL 5K SNIP# 212915408 <br />111i1i1 l 111 lllllrlllN�lil illi l !!ilii l <br />004164507SKs <br />PJODIe prim Qr type, Form deal r+ed for use on elite 12• Itch wrnar. <br />Farm roved. OMS tio. 205U•D039 <br />UNWORM HAYARDOUS <br />jj,0aRaraior1DNLM* 2. Pa of <br />GRL�DQ!Q360705 ;" <br />8 E r sa P <br />"�� 1 m <br />an <br />004164507 <br />s Num r <br />SKS <br />WA'TI9 MANIFEST <br />� y -- - %14 -- <br />1 <br />S, Ganarsto a ame a aling Address <br />alta t 1 E <br />dal <br />Bi Valley Ford Inc Dba Bigg Valley <br />29 g Auto Center Civ un. Mike $altzer <br />�° 't'- <br />Stockton CA "Rip' -28312i <br />�!� �l� <br />Generator' phone. .205--970-�i�IQI <br />1VU � � I. <br />o ^ftl.tDNeSYSTEMSaINC.INC <br />IJ,S. <br />I umber TXR000081205 <br />res, r,e ass -area, an. r;a—s'I.F.m <br />> <br />a-naladre ty 4sma rd Via Addma CLEAN HARBOR'S ARFIOONITE LLC US EPA!ONumber <br />11600 NORTH APTUS ROAD <br />ARAGONITE , UT 84089 <br />4:,5-684-81 r�0 U'fYl981552177 <br />Fetll a Pt>onm <br />la, 90,U $, OOT Desono!bn (Indudlnq Proper 6h1Wna Nems, Haaard CAw ID Number. 10. ContsInwo 11. Tates 12, Unh <br />HM and Paeklrrg Group (I(atiy)) 13. Walla codes <br />No- type Quandly Wt.lVah <br />'NONE NON RCRA HAZARDOUS WASTE SOLIDS, DM P 223 <br />(ABSbRBENTS, RAGSr 011-1), N/A ) <br />F—w„aw-io illq.wuylla anvruulWnal lmwrnauun TSI) - RG 63569059 RIP0683 C90 <br />E4 HR EMERGENCY 11-80Z-469-1760 (SAFETY-KLErEN) fit 00211400 <br />FF ATTACHMEKT <br />16. 0ENSRATVFV5i0FPEROR'3 CERTIFICATION: I hereby datura ihal the 0051ants df ft cortalgnmaM are July and smNialy dowb d above by the pmpor shipping name, AN are Gew&d, packaged, <br />merited and 104161; and are in all respeote In proper omdiflon for Iranapol amordtng to appN®We Intemadonal am national governo•anlel regulatlons. 0 eVort an!pment end I am the Primary <br />Elrportar, I cw*U .Uisl the vont nit of Ns consignment oonhxm W the forma d the ettaGhad EPAAaknowledgment of Consent. <br />106M tuet IN WNW rNNrNrauon etalomant IdWilled In 40 CPR 26127(a) (!f 1 am a larya quarNry genararpr a (b) (MI am a amau quant',ty genaretor) Is (rus, <br />e r e s PrinwrTyped ame� <br />n� y <br />- •e,� c�o4 I S'I (Kit <br />�11310 <br />LJ Import to u B. <br />)nf)� <br />Recelpl of Matadala <br />Erporlln(n,U,S. fortoranvylem; <br />Date Iaavirta US._ <br />to.Olscrapancy - <br />lea, Drsorepancy indloatlon Spam <br />' 7j Quenllry �T%pa ❑Aaaldua <br />is AllemaleFadhty(or Genaretor) Matlfat Numb <br />Fatadys Phona: <br />®1 nature of Alternate ad or enanttor <br />11-- 14, Haiardoua Weals Report Mrinagemerx Mathod Codes (1,a., codes for hacatdoue waste Irawmsnt, disposal, and recyd ng ayslems} <br />Z0. Des; naiad Facility Comer onOperator. dNncatlon of receipt of nazeMorm materials Wvered.by ma manuast a rept as ndsd In Ilam 168 <br />S� rat! <br />EPA r 4951( 31144 �°ua 01W3 are obsolete. DE N Ep <br />Penial %%wort <br />S. EPA 10 Number <br />I <br />❑ Full Rq don <br />DESTINATION STATE (IF RE'-QUlfi D) <br />