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SSL SK SH P# 22859 807 1111111111111111111111II IIII11111 <br /> 006960163sxs <br /> Pieria print or type s Form Approved.OMB No.2050-0039 <br /> UNIFORM Y.AZARDOUS 1 Generator ID Number 2 Page 1 of 3 me R s se Ph ne 4.Manifest Tracking Number <br /> WASTE MANIFEST <br /> 111 CAL0004?_5303 - �� - "�� � 0 0 6 9 6 016 3 SKS <br /> 5.Generator's Name and Mailing Address Generator's Site Address(If different than marine;address) <br /> Saro3ner Trucking/Classic Sales In <br /> '2577 W Yosemite Ave <br /> MANTECA CA 95337-9FA1f <br /> Generffi�pp's Photo � 209-249-3204 <br /> s.Tr tt Ye Yt�N SYSTEMS INC u.s.EPA IDNumber TXROOOOBIP05 <br /> j 7.Trnspor[.v 2 Company Name �� U.S.EPA ID Number <br /> GLEAN HARBORS ENVIRONMENTAL SVC INC. �1_ MF1D039322250 <br /> s-Designated-radtAyPrameandsaeAddiess CLEAN HARBORS OF WILMINGTON US.EPA IDNumber <br /> 1737 EAST DENNI STREET <br /> WILMINGTON , CA 90744 <br /> 310-835--9998 � Cf�DO###29835 <br /> �PaClllysPhore' <br /> r a 9b U.S.DOT D scrotion(i'wlati e;Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes <br /> HMI and Packing Group(if any)) No. Type Quantity WLIV01. <br /> NON RCRA HAZARDOUS WASTE LIQUIDS! (OZL P 223 <br /> C5 WATER) <br /> eS A <br /> ul 7A/iLPA 1AAZA?,Dt` > L4`l L,,'c <br /> AT <br /> 1 <br /> I 3 <br /> i <br /> I <br /> 4Special Handling ns end Adduional Information TSD-WI 80183380 SA15065 CSG. <br /> 24H EMERGENCY#800-458-1760—CHtSKPTEI—Contract retained by generator confers aency authori y <br /> on aJa 1 tr = n as behalf, <br /> 15. GENERATOB'S/OFFFROR'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 /> ma ked and labeled/placarded.and are in all respe<3s in proper condition for transport according to applicable International and national governmental regulations.If export shipment and I am the Prlmary <br /> Export r I certify that the contents or this consignment conform to the terms of the attached EPA Acknowledgment of Consent <br /> I uer'S"that the waste mm mizatlon stat mentidentified in 40 CFR 262.27y)(if I am a large quantity generator)or du(41 am a small quantity generator)is true. <br /> Generatrrs Ofieror's Panted/Typed Nam Signature Month Day Year <br /> 3 <br /> 1°t <br /> _a 16.International Shipments r <br /> F- Import to U.S. ❑Export fr mot Pod of entry/exit.._,__ _ <br /> _5 Tmnspo ter signature(for expors only)'. Date leaving U.S. <br /> q_ 17.Transporter AtenteNledgment of Receipt of Materials <br /> 0' To or'..r 1 Pr r ed/Typed w me SI Month Da Year <br /> c'_ Ac tv `� � o cs P <br /> saJzaIpfpkfrocn2FuapzaCTvpod Name Whom meth Qay Year <br /> �_ _Ai 7 <br /> 18.Dschgancy <br /> 1 S-Discrepancy Indication Spare ❑ Quantity ❑Type ❑Residua ❑Partial Rejection ❑Pull Rejection <br /> _ Manifest Reference Number'. <br /> >: 18t bAlte <br /> . rnate Faculty(or Grator <br /> eneU.S.EPA IO Number <br /> s <br /> <oca <br /> u- Fadi Ayre a.ne'. ' <br /> Ej 18c Srna ire ofAltemae FaaF.ty(or Gonerotor W Menth Day Year <br /> vi19 Era orders Waste h pori IM rogement Method Codes fre.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 2. <br /> 20.Desiccated t'aailiv DAnar of Trot star:Cedificaticn of receipt of hazardous.materials covered by the manifest except as noted in Item 1 B <br /> Pun d Typ d Home Signature Month Day Year <br /> A yl <br /> PA For,arTd2z(Re 12 17) Pm Bio ditions are ons to OR$tGNATE FACILITY O EPA'S e-M ANIFEST SYSTEM <br /> 1)74431' /7 3356�#0 )e -7LIy a j=: ai J SLC 3�{C <br />