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' SSL SK SHIP# 229107915 111111111 11111MINIMI 11111 <br /> 007181585SKS <br /> Please print or type � Form Approved. OMB No. 2(350.0039 <br /> UNIFORM HAZARDOUS 1 G SOP 10 Number CAD9$2336141 2' Page 1 d [[me <br /> . W 1760 4. Manirest Tracking Number KS <br /> ,,t WASTE MANIFEST K <br /> 5 Generators Name and Mang Address Generator's Site Addrass (d dflarent ti,an matTdtg address) <br /> Murray Trailers A Division of Hogan Mfg . , Inc . <br /> "—T75iF`� trtar i po s I—xtf l <br /> STOCKTON CA 95205--7790 <br /> Generator's Phone 209 -838,— 7323 <br /> e T�M SYSTEMS INC U S. EPA 10 Number T X R000081205 <br /> T Transporter 2 Company Nam U S EPA 10 Number <br /> CLEAN HARBORS ENV SVC INC . MAD039322250 <br /> B. DeslsgnaWFaddy Nam end Silo Wass CLEAN HARBORS ARAGONITE , LLC US. EPA IO Number <br /> 11600 NORTH APTUS ROAD <br /> ARAGONITE , UT 84029 <br /> 435-884- 8100 UTD981552177 <br /> Fadlitlls Phone <br /> v . <br /> 9a 9b U.S DOT OescriPtion (wxft&g Proper Uippin9 Name, Hazard Class 10 Number, 10. ConWlers 11 , Total 12, Unit 13 Wade Codas <br /> - HM o. TYN '- .. _ � WtiVd. <br /> t NON- RCRA HAZARDOUS WASTE , SOLID , ffir DM P 352 <br /> o ( PAINT BOOTH FILTER ) , 14P,4P <br /> z 2 <br /> w <br /> c� <br /> 3 <br /> 4 <br /> 14. Spedat Handtxgg InSWOMs andAddibo(W tntomnabon TSD : AG 80732283 MU 17758 CSG : <br /> 24H EMERGENCY# 800-468- 1760�CH / SK / TFI -Contract retrained by generator confers a envy authori y <br /> an initial transpnCtiar to add 04 substitute additional tran5pnrtPrt; nn p hPhalf&, 1 <br /> 15. GENERATOR'SfOFFEROR'S CERTIFICATION; I hereby declare that the contents or bin cons4vnent are My and accu atey desaibed above by the proper 00A name. and are clusft packaged, <br /> marked and tabeledlplacardW, aM are in e0 respects in proper ca+ditim Ior hangar( accordog to appicable Wernabonal W nabonal gowmimental regutations. N export 0ipment and 1 am the Primary <br /> Exporter. I certify that the coWmts of fis cand+gnment c&oifonm to the terms of the a0adied EPAA* W+Acdgmenl of ConW1. <br /> 1 certify that the waste rnlrwniza ata I ldenff*d 4 C *27(a) (d I am a large quantity owwtorj or (b) (d I m a small quantity generator) is true. <br /> Genera alOflerofs C T 1 ( �� Sgnature Month Day Year <br /> 5 18. tera U <br /> tmporl to U S . <br /> Exaort from U.S. Port d enbyfex3ti Y <br /> Transporter signature (for exports my): Date tore S <br /> � 1T. TrancporterAdv�aaledgmerdolReoeipt <br /> T PrinlodR N Sgnahre Month Day Yeaz <br /> CL / <br /> "x <br /> .1rarmoder 2 PrZtidavped Name p+jy 1 r <br /> 1e. <br /> 4007 <br /> 18x. Ossaepartcy Ind cation Space ❑ Ouan9ry El Type IJ Residue I _1 Partial Rejection I Reject on <br /> Manifest Reference Number <br /> 18b Alternate Fad:y (or Generator) U. S EPAfD Number <br /> U <br /> Faditys Phone: <br /> ,4 18c. Signature of Alemate Pacility (or Generates} Month Day Year <br /> 4 <br /> 2 <br /> 19. Hazardous Waste Report Management Meetod Codes (+ e, codes fes harardaru waste treatment, dsposal, and recydhg sys'.ems) <br /> 1 2 3 <br /> 20. Desognated FaciUy Owner or Operator. Certika5on of recap( of Naz *m materials covered by the mv60 except es noted N Item f8a to <br /> Pfinwm to El <br /> ! 1 3 IMIA& ( � Year <br /> EPA Form 870x22Rev. 12.1 PreA ws ed'd3oos are obsolete. DESIGNATED FACiI. TO EPA's e•MANIFEST SYST M <br /> 1 ) 8582383/ 1807330 <br />