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SSL SK SHIP# 229` 15725 <br /> 0073 � 41763K5 <br /> please print or:lyoi Form Aloprpve¢.OMB No.2050-003.9 <br /> 1 Generatal ID Number 2 Page 1 of 3: me R s o.P 4;Htanifaet7racking Number <br /> UNIFORM HAZARDOUS. CAL9�004253$3 1 e�°c <br /> WASTE MANIFEST O �1 1 SKS <br /> a� <br /> 5f Garurratora:iVameandMailingAddrass Ganelct&r Site Address(Itdilfafeiilthenlnaillrjgrirldre") <br /> G'ardn.er TrtxXk hrog3n :assic Sales In <br /> 2577.. W .Yosemite Ave <br /> MANTI»QA CA 95337.9641 <br /> Gof610ns gVhane:-_ 209-249-3204 <br /> SYSTEMS INC .,_ . 074 P4tDhlumba4 TXR000081205 <br /> Ts Torlar2 U:S:EPAJO NpabarrSCMASNFOeG ENV SVC INC. M00393222150Il <br /> te4;fCLEAN! HARBORS ARAGONITE, LLC <br /> 8,CresignaadllyNama ane°$iteAadross U.S.EPA ID Number <br /> 11600 NORTH APTUS ROAD <br /> ARAGONITE , UT 84029 <br /> 435-884-8100UTD9F!1552177 <br /> VA01 Moral: <br /> Bb,U,S,DOTDescdpuon(including Proper shipping Name,Hazard Class,l0 Number, 10 Containers 11,Tolai 12.Unit <br /> ga: 13.Waste Codes. i <br /> HM and Packing Group(If any)) No. TYPO: Quantity Wt.Nol. <br /> X ?' UNi.99�+3, WASTE FLAMMABLE LIQUIDS DM P DOO1 D018 213 <br /> o ' N.O.S. , (GASOLINE, DIESEL), 3, bra II Z ` <br /> Z z. <br /> u.r <br /> c� <br /> x <br /> 4. <br /> 14,3pecia H—andling aelructlens and Addlllonal Information TSD:AI7 81583526 ... ..SA 15065... CSG- , <br /> 1')ERG#128 <br /> 24H EMERG�NCY#800-468-17601—CH/SK/TFI—Contract retained by generator confersaggency authority <br /> on initial transporter to add or substitute additional transporters onenerator' s behalf. ' <br /> 15, GENERATOR'StOFfERORCERTIFICATION: 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 fabatedlptacarded,and are in all respecls in proper condition for transport according to applicable International and national governmental regulations.If export shipment and I am the Primary <br /> Exporter,I Gsrilfy that the contents of this consignment conform to the terms of the a€tacked EPAAcknowledgment of Consent <br /> I certifylhatthe waste minimization statement Identified in 40 CFR 262.27(a)(If l.am a.large quantity generator)or(b)OR am a small quantiiygenarator)Is We, <br /> eaneretahstofferot's Prfaffyped NomV mopft pay: rmr• <br /> te <br /> c <br /> (B,;ntemdUcrta <br /> '�narlis ❑ <br /> ,Import to U.S. ❑Export Pram U.S, (?od ufanhY(.kif; <br /> .Transporter signature(for exports only): Date leaving U.S, <br /> 17.Transporter Acknowfedgment of Receipt of Materials <br /> } : raE£agorttof 1 Pdntodffyped ame. hrre, flandi Day Year <br /> O <br /> Trans, €ler2:R effTyped Nami .. .. elute Month Day Year <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space E quanilly ❑Type ❑Residue ❑Partial Rood. ❑Full Rejection <br /> Menifest:RdfetoncsN fife"r.: <br /> 1eb:Allemalo Facility(or Geneotor) U.S,EPAID Number <br /> Faei6".Phone: <br /> 18c,Signalura of Alternate faclfi (or Generator) Month Day Year <br /> a <br /> P To,Hazardous Waste Report Management Method Codes((.&,.codes for Iiaxerdous.Was atment~dispoesl,and recycling systems) <br /> tn: .. <br /> 1 2 3 4, <br /> 28,Designated Fachity Owner or Operator:Cerglicalfon of receipt of hazardous materials covered by the manifest except as nded In Item 186 <br /> Pr nla fTSrped Name Signature Month Day Year <br /> bus editions are obsolete, DESIGNATED FACILITY 015POO-MANIFEST SYSTEI ' <br />