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•. � -.mama -- � .---� ,. � . <br /> 45 <br /> SL , SK SHIf?iijAgA9973 <br /> _ - . . . <br /> LOLL <br /> P print or type. Form Approved. OMB No. 20.50-0039 <br /> UNIFORM HAZARDOUS t• G aerator ID Number 2: Page l of 3. Eme R p d, Manifest TrackingNumber ' <br /> WASTE MANIFEST CALo000413716 !F—� ` a 560 <br /> 6O V <br /> 5. Generators Nameand Ma�1m' g Address ��^ . ' � Generator's Site Address in different than maling address) tJ0 1� <br /> Caliber COX ision — Stockton # 1060 . 4 <br /> 3210 •N Wilson Way Location ID# matt 1060 <br /> STOCKTON CA 95285-0000 <br /> cenarabr's 209-469-7091 <br /> SYSTEMS INC, U.S. EPA ID Number TXR000081285 <br /> T. Traspoder2 Carpo Name U.S. EPA ID Number <br /> CLEAN HARBORS ENV SVC INC. MAD039322250 <br /> i B. Designated FadiryName and Site A.ddress CLEAN HARBORS EL DORADO, LLC <br /> " U.S. EPA Y) Number <br /> 309 AMERICAN CIRCLE <br /> EL. DORADO , AR 71730 <br /> 870-863-7173 ARD869748192 <br /> Fad s Phone: <br /> ga. 9b. U.S. DOT Description ondudng Proper Slepphg Name, Hazard pass, ID Nurr"ber, 10. Containers <br /> HM and PaddngGroup (dany)j No. Type Quantity1WWdt 13. Waste Codes <br /> i X 1, RQ UN1950 WASTE AEROSOLS, ( EACH NOT DM P D061 DOOb D006 <br /> �o EREEDING 1 L CAPACITY ) , 2. 1 ( DO01 ) <br /> D097 D088 331 <br /> Z 2. <br /> i <br /> 3. <br /> t . 4. <br /> M <br /> 14, Special Handling Instructions and Additional Information TSD : EL ' 80924329 CA65817 CSG : <br /> 1 ) ERG# 126 • ; ( � v inti t ( 1 3 Q <br /> 24H EMERGENCY#WOtl 468- 1760-CH/SK /TFI -Contract retained . by generator confers a enc y authori y <br /> on <br /> initial trans orte to ad s bs ' t i <br /> ehalfe <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: i hereby declare that the comenfs of this ouropment are futy and accurately described above by the Proper shipping tone, and are classified, packaged, <br /> " •u markad arrd labeledlplacarded, and am in al respects in Proper condition for transport according to appicatgo intematlonaland national governmental regulations. 8expon sh'pment and 1 sm the Primary <br /> ;� . <br /> Exporter, I car* that the contents of Ods mnsigmtent M*mrto the terms of the attached EPA Acknowledgment of Cartsenl. <br /> I codify that Ne waste rdoumbon statement Identified in 40 CFR 26227(a) (d i am a large gwr#y generator) or (bVR ama spall quantity generator) is true. <br /> r , Generetof rp's Prinled/Tme signature Month Day Year <br /> 16. In al Shipments Impb U.S. <br /> a <br /> -Transporter signaWre (forexpods only): ort El Export from U.S. i ort of entrylexit <br /> Date leaving U.S.: <br /> 0: 17, TrempaferAcWavAedgmentof Reoeiptof MaterialsNor - <br /> . W? Tre art Wntedrtyped me Signature Monty Day Year <br /> wOLU pros5 ax <br /> 2 Pi Name <br /> M0jA Day Year <br /> A 18. saepancy I'MIR Lill 136 1 <br /> to 189. Discrepancy Indication Spans ❑ Quantity ❑ Type Residue ❑ Partial Rejection ❑ Ful Rejection <br /> ManAest Reference Number. <br /> }} 8b. At teiracibig rGen rabr} <br /> U.S. EPA ID Number <br /> c) .- <br /> iOlt. Fadi ys Mena: '...'... <br /> tBc. Signature ofAitemafe Faaldy (a Genewbr) _ Month Day <br /> y19. Hazardous Waste Report Management Method Codes (.e., codes for hazardous waste treafineot, diaooitebarxf recong system) ' <br /> p 1 • Waqo 2 g• .. � .. ��" � 4. <br /> 20. Designated Fad q D,vner or Operator. Certification of mo*t of hazardous mataUs covered by the manifest except as rate-din It 18a <br /> Pdnte&TyW Name Signature �y � Month ay ear <br /> EPl ) eb91797 / 1 � 11362 cc's editions are obsolete. DESIGNATED FACILITY TO GENERATOR <br /> F' <br /> i. z v. . . _ <br />