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SSL SK SHIP# 231840156 11111111111111111111111111111111 0 0 7 4 4 0 3 5 6 S K S Please print or type. Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1-Generator ID Number CAL000358631 2.Pagel of 3.JT%gyy ReSQpg:se T7&0 4,Manliest Tracking Number WASTE MANIFEST 1 tt33I1U0I111ii 4GtS 1 ( 1007440386 SKS 5.Generators Name and Mall Address Generator's Site Address(N different than mailing address) n D & D Lift Tne. 3820 Rhonda Way TRACY CA 95304-1608 Generators Phone: 209-229-7440 6.T'9WFV—'TXVEN SYSTEMS INC U.S,EPA 11)Number TX R000081205 7.Transporter 2 Company Name U.S.EPA ID Number CLEAN HARBORS ENV SVC INC. MAD039322250 8.Designated Facility Name and Site Address CLEANHARBORS OF BUTTONW I LLOW U.S.EPA ID Number 2500 LOKERN ROAD BiJTTONWILLOW GA 93206 661-762-6200 CAD980675276 Facility's Phone: ga. 9b-U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13-Waste Codes HM and Packing Group(if any)) No. Type Quantity Wt.Nol. OTumull z' }�jC�,1� (l CQ 7Ar avS W She SOItG� S 'Oi�� Z-300 '� 3 yE 5,"��tievrhl�� rbLw.�r�,,) 3. 4. 14,Special Handling Instructions and Additional Information TSD:BL 83661931 DD027 40 24H EMERGENCY#800-468-1760—CH/SK/TFI--Contract retained by generator confers3 a ency author y on initial transporter to add or substitute-additional transpqrters onloenera or' s behalf. , 15. GENERATOR'SIOFFEROR'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, 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 Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgmert of Consent. I Dertify that the waste minimization statement identifred in 40 CFR 262.27(a)(if i am a large quantity generator)or(b)(itl am a small quantity generator)is true. Generator Offerors Printed/Typed Name Signature _ � Month Day Year 113.International Shipments I-- ❑Import to U.S. ❑Export from U.S. Port of entry/exit: ? Transporter signature(for exports only): Date leaving U.S.- 17.Transporter Acknowgment of Receipt of Materials Transporter 1 Print yped N Signature Month Day Year cc d ✓ r& rZo Z Transporter ntedff Name Sigtur Month Day Year CJ 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number _J C) Facility's Phone: W 18c,Signature of Alternate Facility(or Generator) Month Day Year a Z w 19.Hazardous Waste Report Management Method Codes(i,e.,codes for hazardous waste treatment,disposal,and recycling systems) G 1. 2. 3. 4. 20.Designated Facility Owner or Operator Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Pdrtedf typed Name Slg ature Month Day Year EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM Z}vt�oS%-N/ISO ca53(o