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SS1, SK SIAIP# 22321 15541 1111 11 1111 1 <br /> 0061192523SKS <br /> Please print or type (Form designe-d for use on elite(t2-purls)typeaenter) Form Approved,OMB No,2050-0039 <br /> 14.Mandest Trad-1 N be <br /> UNIFORM HAZARDOUS ,cionera'�or 15 Number CAD982501-736 1 par Of EMULUgn <br /> �OU <br /> WASTE MANIFESTJ 00 "M23 SKS <br /> 5 Gorkinalor's Name and Mailing Address Gnemv),s Sita Address(J different than mailing address) <br /> Cal—Trans Shop 1@— 30110 CiNs <br /> 1603 S D St <br /> STOCKTON CA 95206--a476 <br /> Generators Phone; 209--948-7813 <br /> OftWL-REVWSYST EMS INC U.S,EPA ID Number TXROOOOS1205 <br /> 7 Transpodef2Conpany Name U.S EPA ID Number <br /> CLEAN HARBORS ENVIRONMENTAL SVC INC. MAD039322250 <br /> 6 Desqnatocl Fadhty Name ati,&te Address CLEANHARBORS OF BUTTONWILLOW US EPAIDNumber <br /> 2500 LOKERN ROAD <br /> 661-762-6200 BUTTONWILLOW CA 93206 CAD98067527S <br /> Facilrys Phone: <br /> % 9 U.S.DOT NsCrplxm(including Proper Sb ppng Narno,Hazard Class,0 Number, 10 Containers i I Total 12 Unit 13,Waste Codes <br /> HtA and PPckwq Group(5 any)) —Type— Quant,ty, ft'vol <br /> ' NON RCRA HAZARDOUS WASTE SOLIDS DM <br /> 0 (WIPES, POLYPROPYLENE, PPE, OILS <br /> Z 2, <br /> ca <br /> 3 <br /> i4,Special Handling mslrsmion5 and Additional Information T9D:0L 74556054 CA47954 CSG: <br /> 24 HR EMERGENCY #1-800-468-1760 (SK TFI) 11b <br /> AUTH AS "AGENT-FOR" BY GEN TO RETAIN LICENSED SUB CARRIERS AS NECESSARY . <br /> 15. GENERATOR.S(OFFEROR'SCERTIFCATION:1 hereby declare thar:the contents of this cons4vient ate fL*and Rocuratety desteted alpm by the proper shicong name.orld we classified.packaltefl. <br /> marked and labeted/placarded,and are in ail respects in proper condition for transport occurring to a;#XaUe a temat nv and national greremmental if export ship rivne,and I am the primary <br /> Exporter,I cendy that the contents of this consignment conform to the terms of the attached EPA Acknowiedgment of Consent <br /> I cerley that fine waste minimization statereml,identified in 40 CFR 262 27(a),if I am a large quantity generate)or to)(if)am a small quannt, generator)is lue. <br /> GermmLy ntedlyped N 7, sviiaeure h <br /> -or' <br /> 'o , <br /> 16 internal shipments Inwrt to U S EW 4om G S. Part of enLrwexit. <br /> Transporter mature(for exports o0y) Date leavitso US: <br /> 17 TransporferAckmy*ki�i niolRemptol'Malarals <br /> et'4 Pfmtedqy;�X.— Day year <br /> I( <br /> Tran n Typed Norm, sigmewe Monte Day Year <br /> C-4= <br /> 18" panty 7— <br /> 18a,Discrepancy Indisawit Space Quantity type Residue 0 Portal Raj",ion El Full Rejection <br /> ManiW Reference Nomber, <br /> arat0f) VS EPA ONumlber <br /> 18c,Sgnalom al'Allemate Facility—(orG—ene—rat-or) hbnth day Year <br /> 4s,t as ieste RepwKinagetrew MoV*d Codes(it-,codes for hazardous waste tfeatmient,dispostxi and torcychng systems) <br /> LLJ 1, 2, <br /> 2g Designated Faci.'ay at opaidlof,Certification of receipt of he does materials Covered by the manifest except as noted in Item 18a <br /> ty D ear <br /> IA <br /> If)"ej s editions atk6sioyite, DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br /> W1 <br />