Laserfiche WebLink
SSL SK ,SHIP# 228591782 1111111111111111111111111111111111111111 <br /> 0 0 6 9 6 0 1 5 9 S K S <br /> Please print or type. Foran Approved.01106 No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emer&&Re ggS Phgng 4.Manifest Tracking Number SKS e <br /> WASTE MANIFEST CAL000425303 1 1—tl@10-468-1/b0 0 6 9 6 015 V„V <br /> 5.Generators Name and Mailing Address Generators Site Address(A different than mailing addressl <br /> Gardner Trucking/Classic Sales In <br /> 2577 W Yosemite Ave <br /> MANTECA CA 95337-9641 <br /> Generator's Phone 209-249-3204 <br /> 6.Tr�n*pFr(pg1Y mpan>E& SYSTEMS INC US EPA ID Number <br /> SF1 ET 1CL t1V TXR@0@081205 <br /> 7.Transporter Company Name U.S.EPA ID Number <br /> CLEAN HARBORS ENVIRONMENTAL SVC INC. MAD039322250 <br /> 6.Designated Facility Name and Site Address CLEANHARBORS OF BUTTONWILLOW U.S.EPA ID Number <br /> 2500 LOKERN ROAD <br /> Facility.Phone: BUTTONWILLOW , CA 93206 <br /> 661-762-6200 CRD980675276 <br /> ga, gb.U.S.DOT Description(including Proper Shipping Name.Hazard Class,ID Number, 10.Containers 11.Total 12.Umt <br /> HM and Packing Group(if any)) 13.Waste Codes <br /> No. Type Quantity Wt/Z <br /> (GREbSNON RCRA HAZARDOUS WASTE SOLIDS, DM P 352 <br /> W <br /> NWII � 03 360 <br /> z NON—RCRA HAZARDOUS WASTE l�N( P 331 <br /> LIQUIDS, (DIESEL EXHAUST FLUIDI,Irl"iTr <br /> O I Q O <br /> 3 u� <br /> 4. <br /> 14.Special Handling Instructions and Additional Intonation TSD*BL 80183380 GA15065 , Ah�,y�Cq"S�G* �� <br /> 24H EMERGENCY#800-468-1760—CH/SK/TFI—Contract retained by generat�f c` RPrsa ency authori y <br /> on initial transporter to Add or substitute Additiana 11a <br /> 15. GENERATOR'SIOFFERORS 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, <br /> marked and labelecloacarded,and are in all respells in proper condition for transport according to applicable international and national governmental regulations.If export shipment and I am the Primary <br /> Exporter.I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. <br /> I the"that the waste mmim¢ation 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. <br /> Generators/Olfemrs PrinledFryped Name Signature Month Day Year <br /> Sh.\ o(o o l l°I <br /> J 16.International Shipments <br /> F_ Import to U.S. ❑Exposo U.S. Port of entry/exit:? Transporter Signature(for exports only). Dale leaving LLS.: <br /> tK 17.Transporter Acknowledgment of Receipt of Matanals <br /> aTporler 1 PnOtedHf ypetl Na Month ��Day �YIr <br /> z Transporter( 21PriinteedRYyped Name azure <br /> Month Day Year <br /> 9 , v 6 <br /> 18.Oiserepaocy <br /> 18a.Discrepancy Indicated Space try ❑ <br /> Quart Type ❑Residue ❑Partial Rejection El Full Rejection <br /> Manifest Reference Number. <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> LL Facility.Phone'. <br /> w 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> a <br /> Z <br /> 19.Hazandoys <br /> Waste Report Management Method Codes h e.,rpdes for hazardous waste treatment.disposal,and recycling systems) <br /> 1 20 Designated Facl ner or Operator Certificatlon of receipt o azardous materials covered by the manifest except as noted in Item 18a <br /> Pnnted(lypetlNa lure Mon Day Year <br /> EPS 7at%8i%V )/S61704A 2B29969/ 846616 3 <br /> DESIGNATED FACILITY TO EPA's e-MANIFEST SY TEM <br />