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0 <br />SSL SK SHIM 222051181 <br />Please print or type. (Forth designed for use on dice (12 -pitch) typewriter.) <br />005693292SKS <br />Fort Approved. OMS No. 2050-0039 <br />owner or operator: Certification of receipt of hazardous materials covered by the martfest except as rated In Item 18a <br />wl.� s 17-51111 <br />are obsolete. DESIGNATED FACILITY TO DESTINATION STATE (IFREQUIRED) <br />UNIFORM HAZARDOUS <br />I'- Generator ID Number CAR080883287 <br />2. Pagel of <br />3.1T- Reese JXq _ <br />t3Wlp 4bti 1 lblD <br />{0 0 5 8 9 Number be 9 <br />WASTE MANIFEST <br />fi V <br />5. Geteraf a Man* and M*V Address Generaws Site Address (A ditwd than mallrg address) <br />Swift Co <br />Latl�tation <br />CA 95338-6764 <br />ftE*W$58-7027 <br />b, SYSTEMS INCU.S. EPA ID Number TXROSS881285 <br />7. TrarWortar 2 Company Name <br />V <br />a. Designated Fadily Name and site Address CLEAN HARBORS OF WIU I NGTON LLC U.S. EPA ID Number <br />1737 EAST DENNNI STREET <br />WILMINGTON , CA 90744 <br />318-835-9998 CAM44429835 <br />Estills Phone: <br />ga. <br />9b. U.S. DOT Description (including Proper Shipping Name. Hazard pass. ID Number, <br />10. Containers <br />11. Tda1 12. Unit <br />HM <br />and Pad* G -P (It airy)) <br />Quantity WtNal. <br />13. Waste Codes <br />No. <br />Type <br />' NON—RCRA HAZARDOUS WASTE, SOLID <br />DM <br />P <br />223 <br />o <br />(OIL FILTERS)O <br />W <br />2. <br />0 <br />3. <br />JU <br />4. <br />ENV <br />ONM NTA <br />J I=ALT <br />DFP R <br />14. Handy Instrutibrrs adaddaonal Mtom�Aen TSD: WI 73345482 SW 10083 CSG: <br />24 HR EMERGENCY S1p800-468-1768 (SK ! TFI)AM AS BY 90 TO RETAIN LICENSED SUB CARRIERS AS WXESSAJI —7Ro � <br />15. GENERATOR'SI0FFEROR'8 CERi1FICATION: I hereby declare that the contents of this consOwnent are Arlt' and accurately described above by the proper shippbg name, and are cltsdfled, packaged, <br />marked and labeled*carded, and ars in all ragvcft in props condidon for transport according to applicable intemationat and national govemmerm regulations. It export shipment and I am the Primary <br />Exporter, l of* Aral Are oorterrfs of this oarsigematt =VbM to the terms of the allched EPAAdmowladgrnert of Consent. <br />I w* that the waste mtrtir* Am statement ftWAed in 40 GFR 26227(a) (8I am a large quantly genarelor) or (b) kV I am a small quantitygaarator) is true. <br />Genaratoes/OAerors; PrirrkNfyped Name Signa Monttht Day Year <br />� <br />F– <br />ib. lntematrorwl SFtpments <br />❑ Import U.S. ❑ Export from U.S. o+t of enbylexit <br />z <br />Tramsporbr Signature (for export9 only): Date" U.S.: <br />W <br />17. T ansporterAdmowWgment of Receipt of Maferids <br />p� <br />Transporter 1 Printed/ryped Name Day year <br />\ Month Day <br />y <br />' <br />U1 LA&j 0 O1 11 <br />Q <br />a <br />Transporter 2 PmWyped Name lZi% Sigmyymye `0 Yea <br />/- �i/ t <br />S4 <br />{ 1 <br />18. Discrepancy <br />18a. Discr"ncy Indicabon Space ❑ Quanw ❑ Type ❑ Ra a. ❑ Partw Rejection ❑ Ful R*.Won <br />Manifest Reference Number. <br />�18b. Alternate Facility (a Generator) U.S. EPA ID Number <br />U <br />FadVe <br />Phone: <br />I& Signaarre of Altemate Faddy (o Generator) Month Day Year <br />Q <br />z <br />19. Hazardous Waste RLA <br />eoW Managemant <br />Mesad Codes (.e., codes for hazardous waste treatment, disposal. and recycling systems) <br />w <br />IC 1 2 <br />owner or operator: Certification of receipt of hazardous materials covered by the martfest except as rated In Item 18a <br />wl.� s 17-51111 <br />are obsolete. DESIGNATED FACILITY TO DESTINATION STATE (IFREQUIRED) <br />