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ZJ Z <br /> SK S' IP# 226331447 <br /> Please print or type. Form Approved.OMB No,2050-0039 <br /> J_ <br /> 1.Generator ID Number <br /> 2 <br /> 4.Manifest Tracking Number <br /> 00 CA09822501 736 <br /> UNIFORM HAZARI)OUS <br /> WASTE MANIFEST 668"174 4 5 SKS <br /> 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) <br /> Cal-rrans Shop 10- 301 W Curs <br /> 1603 9 B st <br /> STOCKTON CA 95206-2476 <br /> Generators Phone: 209-948-7813 1 <br /> 1.T,! Cpmp SYSTEMS INCU.S.EPA ID Number <br /> TXROOOOS1205 <br /> , <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> DLEAN HARBORS ;_:NY1R.0NWNTA1_ SVC INC. MAD039322250 <br /> 8.Designated Faulty Name and Site AddressU.S.EPA ID Number <br /> CLEFIN HARBORS ENV TROHMS NTAL SER VIrEv Tjh4 <br /> 22, 47 S HIGHWAY 7'. <br /> Facility's Phone: KIMDAU. NE 69145 NED98 1 <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.Nol. <br /> X I UN I 22&�'33 6XI'ST E PP I N-i 3, PS1 IT 1 1, F00-2 F0055 D001 <br /> 0 <br /> !;R 00011" MIS 212 <br /> LU <br /> Z <br /> LU <br /> 3 <br /> 14.Special Handling Instructions and Additional Information T3,02 KP 7 83 5"172 CA 4 7 93 4CeSG. <br /> I)E`+d€2# 1!D 8 <br /> 24H EMERONCY#800-4-619-1760-CH/SK/T F I-Con t ra�c t rera ined by generator Confers a ncy authority <br /> .1 <br /> on-iiti <br /> nal traTIS-omen r-to add osubstitutp. ad,di4.rrl <br /> ,tional tas2ens or. ganeraur' s tehalf, <br /> 15, GENERATOR'S,'OFFEROR'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, certify that the contents of this consignment conform to the terms of the attached EPAAcknowiedgment of Consent. <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)��(b)(if J'jam a small quantity generator)J_t1_­ <br /> Signature) Month Day Year <br /> A- <br /> 16 riternation&Shkoments <br /> D,❑Imilort to U.S. El Export from U.S. Port,of entry exit: <br /> Tar!s.,,olqr s;grature ffor exlpper�ss on!y) Date leaving!J.S.: <br /> W 17.Transporter Acknowledgment of Receipt of Materials <br /> 777:�7djyped Nam I e Signature Month Day Year <br /> 0 <br /> J <br /> Z <br /> Transporter 2 PantediTyped Name Signature m. Month Day Year <br /> 18a Discrepancy indication Space Quantity El ❑Type Residue ❑Partial Rejection El Full Rejection <br /> Manifest Reference Number: <br /> 18b,Alternate Facility(or Generator) U.S.EPA ID Number <br /> _�acility's Phone: <br /> 18c,Signature of Aitemate Facility!,or Generator) Month Day Year <br /> LLJ <br /> !ZC <br /> Z <br /> 19.Hazardous Waste Report,Management Method Codes(i e.,codes for hazardous waste treatment,disposal and systems) <br /> U -7- 7 <br /> 12. 3. 4. <br /> 20,Des,gnaned r_adiivi Owner cr Operator Certification of receipt of hazardous materials covered by the manifest except as noted n!tem.18a <br /> Name Signature Month Day Year <br /> EPT--)0CPy, (R-v Z),Previous editions are obsolete, <br /> GENERATOR'S INITIAL COPY <br />