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SPL 5K SHIP# 2228759904 - - 1111111 III ��II �I� I 'II <br /> ( 00 9536343K3 <br /> Form Approved. OM6 No. 20500039 <br /> Pleaseprint or type. 2. page of 3. me R e P 4. Manifest Ire Number <br /> UNIFORMHAZARDOUS LGereratorlDNumbe CAL000413716 - - - �� 0 ( 6 X3634 SKS <br /> WASTE MANIFEST <br /> address) <br /> S. Generatorme and s NaMatting Address Generetofs Site Address (il di8erentlhen maAing <br /> Caliber Collision - Stockton # 1060 <br /> 3210 N Wilson Way Location ID# - 1060 <br /> STOCKTON CA 95205-0000 <br /> Generators Phone: 209-469-7091 11 11U.S. EPA ID Number <br /> B. Tr aOsooder.��pn'ffy SYSTEMS INC 7XR000081205 <br /> aHYt 15� U.S. EPAH) Number <br /> 7. Transporter 2 Company Nama M6iD039322250 <br /> CLEAN HARBORS ENVIRONMENTAL SVC INC . <br /> 8. Designated Facility Name and Site Address CLEAN HARBORS EL DORADO , LLC 0.S, <br /> EPAID Number <br /> 309 AMERICAN CIRCLE AR 71730 <br /> 870-863-7173 EL DORADO + ARD06974BI92 <br /> Fac'lit s Phone: <br /> 9b. U.S. DOT Description cmduding Proper SRpp'ng Nama, Hazard Class, ID Number, 10. Confa!ners 11 . Total t2. Una i3. Waste Codes <br /> �. No. Type Quantity YANoI. <br /> NM and Packing Group (ifanyjj <br /> X 1 RU UN1950 WASTE AEROSOLS, ( EACH NOT I DM t o P D00 D005 D006 <br /> o EREEDING l L CAPACITY ) , 2 . 1 (DO01 ) / D00 D008 331 <br /> i 2• <br /> w <br /> 3. <br /> d. <br /> 14. Spacial Handling Instructions and PAIGMna lnfwmal'on TSD : EL 80364150 C1165817 CSG : <br /> 1 ) ERG# 126 ' (� 3yLA Sato � O <br /> 24H EMERGENCY#800-468- 1760-CH /SK/ TFI -Contract retained by generator confers aggencs behalfauthori y <br /> on initial transporter to add or substitute additional trans orters on eneratar' s behalf . <br /> 15. GENERATORWOFFEROR'S CERTIFICATION: I hereby declare that Ore contends of this consignment are fully and accurately desarbad above by the proper shipping name, and ere dassd�ed. packaged, <br /> marked and labeledrpacarded, and are in all respects in proper condition for transpod according to apple International and national governmental regulations. p 4XII sh!pmenf and I am the Primary <br /> Exporters I certify that the contents of this consgnment conform to ft terms of the attached EPAAekno+.iedgme of Consent rotor Is Due. <br /> I cedity that the waste minimization statement identified in 40 CFR 262.27(a) (f I am a large quantity generator) ) (rf I am a small quantity gave ) klonth Day Year <br /> Ger�ar Beror �PdntedRyp�ame Signature <br /> Gp �- <br /> 6. international Shipments ❑ Import to U.S, ❑ Export from U.S Pari of entryleul <br /> Transporter signature (for exports only): Date leaving U.S.: <br /> ce 17. TranspaterAduntidedgment of Receipt of Materials Month Day Year <br /> CTre er 1 Print ad Nama Signature / <br /> a (D <br /> Day YE <br /> T nsporter2 Name S'g e Z � <br /> j18. Discrepancy <br /> itia. Disaepancy lndicaBon Space ❑ Quantity ❑ Type ❑ Residue ❑ Partial Rejection ❑ Full Rejection <br /> Manifest Reference Number. <br /> 0.S. EPA ID Number <br /> 18b. Allemale Facaly (or Generator) <br /> J <br /> v <br /> UiFaaI 'hone; Month Day Year <br /> W 18c. Si�tatureofAllematetre ily (or Genera <br /> 6 <br /> z <br /> H 19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste Oeehnenl, dsposal, and recycling systems) <br /> 3. 4. <br /> Q i' Ih1 <br /> w <br /> 20. Designated Fadtity Omer or Operator. Cedifra5on of recelplof hazardous materias covered by the manifest except as noted in Item 18a <br /> G <br /> Mon D�, par <br /> PJintedlTypeoN e Sigreh�g �p 2 � 1 ; e Ti <br /> EPAI) 8 5 91797 e/y18113O.V ous editions are obsolete. ESIGNATED FACILITY ?0 EPA's e•MANIFEST SYSTEM <br />