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SK. SHIP# 226132_4,i7b Please print or type. \G Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number r 2.Pa of 3.Emer en Res rise Phone 14.Manifest Tracking Number WASTE MANIFEST CgD,983641093 1-t�@ 4 8-176121 �+Kc 5.Generator's Name and Mailing Address Generators Site Address(if different than mailing address) SKS Hewitt. Alignment 925 S E1 Dorado St STOCKTON - CA 95206-1313 Generators Phone: 209-948-'8433 6.Tr n alter 1 Compan Nam U.S.EPA ID Number ETY-KL7Eyq SYSTEMS INC ',174 i5 7.Transporter 2 Company Name U.S.EPA ID Number CLEAN HARBORS ENVIRONMENTAL SVC IN MA0039322250 8.Designated Facility Name and Site Address CLEAN HARBORS ENVIRONMENTAL SERVICES, IN U.S.EPA ID Number 2247 S HIGHWAY 71 KIMBALL NE 69145 308-235-4012 NE0981723513 Facility's Phone: ga 91b.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, - Quantity Wt./Vol. X 1' NA3082, HAZARDOUS WASTE, LIQUID{ P D00 D007 DOJJ; O N.0.S. , (CADM I UM, LEAD), , I I a 252 or W Z LU 0 3 4. 14.Special Handling Instructions and Additional Information TSD 6 KP 78269643 HEM35 i)ERG#1?1a ; '1 24H EMERG NCY#8@0-468-1760-CH/SK/TFI-Contract retained by generator -confers agincy authorz on -r transportar to add or substitute additional s r6 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, 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 allached EPA Acknowledgment of Consent I certify that the waste minimization statement identified in 40 CFR 26227(a)Cd I a-a a-==_a '. e e c- : "' a s-a quantity generator)is true. Generatoes/Offerors PdntedLTyped Name S a / Month Day Year ,j 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 Materials LU TragsffdrT r 1 Printed/Typed WemeYoSignature �) Month Day Year- ak1A f Z end Printed/Typed Name re on Day Year 18.Discrepancy 18a,Discrepancy Indication Space ❑ Quantity El Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number. 18b.Alternate Facility(or Generator) U.S.EPA ID Number U ram Facility's Phone: U0 18c.Signature of Alternate Facility(or Generator) Month Day Year t- a z 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) G 1 �I 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 Prnted/Typed Name Signatu Month Day Y EPA Form 8700-22(Rev.12-17�Previous editions are obsolete. DESIGNAtEFACILITY TO GENERATOR i.)7488998/822436 ,