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SSL SK SHIP# 228591773 (III�III��'IIIII"I�'I�II"'I'III'� <br /> OO696O161SKS <br /> nPlease print or type. &2 Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Pa 3. me R s c se P 4.Manifest Tracking Number <br /> WASTE MANIFEST CAL000425303 3, - - �—ibe 00696016 $K$ <br /> 5.Generator's Name and Mailing Address Generators Site Address(if different than mailing address) <br /> Gardner Trucking/Classic Sales In <br /> 2577 W Yosemite Ave <br /> MANTECA CA 95337-9641 <br /> Generators Phone'. 209-249-3204 <br /> 1.Trasnspor6T1Ympan�N�N SYSTEMS INC U.S.EPA ID Number TXR000081205 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> CLEAN HARBORS ENVIRONMENTAL SVC INC. MAD039322250 <br /> 6.Designated Facility Name and Site Address CLEAN HARBORS ENVIRONMENTAL SERVICES, IN US EPA ID Number <br /> 2247 S HIGHWAY 71 <br /> KIMBALL. , NE 69145 <br /> NED981723513 <br /> 308-235-4012 <br /> Facility's Phone: <br /> 9a, 9b.U.S.DOT Description(including Proper Shipping,Name,Hazard Class,ID Number, 10,Containers 11.Total 12.Unit 13.Waste Codes <br /> HM and Packing Group(If any)) No. Type Quantity Wt.NQ1. <br /> X 1UN1993, WASTE FLAMMABLE LIQUIDS DM P D801 D018 213 <br /> o N.O.S. , (GASOLINE, DIESEL), 3, bG II <br /> ®l► �n <br /> Z 2. <br /> Lei <br /> I <br /> 3. <br /> I <br /> i <br /> 4. <br /> 14.Special Handling Instructions and Additional Information TSD:KP 80183380 OR15065 CSG: � <br /> I)ERG#128• O a a� aRoa LJ <br /> 24H EMERGENCY#800-468-1760—CH/SK/TFI—Contract retained by ge erator confers ,aency authb haori y <br /> on initial transporter to add or substitute additional n a r,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, <br /> 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 <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. 1 <br /> 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. j <br /> Generator's/Offeror's Printed/Typed Name Signature Month Day Year <br /> J 16.International Shipments <br /> p_ ❑Import to U.S. ❑Export f .S. Port of entrylexit <br /> ? Transporter signature(for exports only). Date leaving U.S.'. <br /> W 17.Transporter Acknowledgment of Receipt of Materials <br /> Lei <br /> Tra porter1 PrintedrTypedf afne Sign Month Day Year <br /> CL.(4 LS,� o� n 1 <br /> AarrSi Printer yped Name u Moi Day Y r <br /> F <br /> } 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quanti ❑Type 1 <br /> ty y ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> 1 So Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> LL Facility's Phone', <br /> w 18c.Signature cfAltemate Facility(or Generator) Month Day Year <br /> a <br /> z <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> C3 L 2. 3. 4, <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted irultem 18a <br /> Printed/Tyr cl igna Month Day Year y <br /> (Rr� <br /> EPA F 744245cI75 1 3 Previous editions are obsolete. DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM <br />