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7142 SK SHIPN 211120441 IIIIIII I�IIIIIIIIIII IIIIIIIIIIII <br /> 003923743SKS <br /> Please pint or type.(Form designed for use on axle pitch)ty r.) iFonn Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS t.Generator ID N°miter CAD982485351 2.Sz)�m iE"eO46a'—i' I6 n ''0 0 3 9 G 3 7 4 3 SKS <br /> WASTE MANIFEST <br /> S.CAL—TRANS <br /> Name and Ml SHORtld I Generamea Site Address(M dNerent then melting address) <br /> CRL-TARNS SHOP 10- LDDI CWS <br /> 845 E Pine St <br /> Lodi CR 95240-3108 <br /> Genereloes phon: 209-333-6953 <br /> eWg i?4MENWSYSTEMS, INC. U.S.EPA ID Number TXR0OOO812O5 <br /> 7.Transporter 2 Company Name U.S.El ID Number <br /> Clear l cr {v,&4P00 3P- <br /> 8.Deslgrsted Fadaky Name and Site Admeas CLEAN HARBORS GRASSY MOUNTAIN, LLC. U.S.EPA ID Number <br /> 3 MILES EAST, 7 MILES NORTH KNOLLS EXIT 41, OFF I-80 <br /> Fecal Phone: ARAGONITE , UT 84029 <br /> 801-323-8976 UTD9913O1748 <br /> ge, 9b.U.S.DOT Description(including Proper Shipping Name Hazard Clens,ID Number, 10,Containers 11.Total 14 Unit 13.Waste Codes <br /> HM and Pedaling Gw(t any)) No. Type Qua" vil <br /> 1 (A�BE NON <br /> TRRND 0 ZARDNO S WASTE SOLIDS, 0 OM I�,O <br /> 2. P 352 <br /> l/ <br /> cD <br /> 3. <br /> 4, <br /> 14.Special Handling lnsmuctions and Additional Information TSD:117483 61630538 10076580 / '-^]CSSGG; (f/; <br /> 24 HR EMERGENCY S1-800-468-1760 (SAFETY-KLEEN) 551-7 ( 0 3 6`T 3 <br /> SEE ATTIRCHMENT <br /> 15. GENERAMNSIOFFEROR'S CERTIFICATION;I hereby declare that the contents of this consignment are fully and awsaksly described above by he prepershopig name,and are classtsd,packaged. <br /> marked and labeletlfplacarded,and are in 811 respects in proper tandlton for transport accerdng to applicable Interraionatend national governmental regulations.If mrport shipment and I am the Primary <br /> Exporter,I certify that Bre contents of this consignment conform tithe terms of the attached EPAAcknowledgment of Consent. <br /> I cedly that the wale minimization statement identified in 40 CFR 282.27(0)(It l am a lege euen5ty genemil or(b)(ifI am a smal Itygeram"is nue. <br /> G a PdrrNNTypad a 5 Monti Day Year <br /> J 1 .ntsmalonal hl ms <br /> Import to U.S. ❑Fxpathom U.3. Pat ofentrylexil: LEI <br /> Transportsr*nature(for"parts only): Dasa laving U.S.: <br /> 17.TrensParter ment of RecelPt of Matsrials <br /> Trert teMyped <br /> Sign afure Month Day /Year <br /> Tre orNr2 Prin ypetl a gnafure Mon Day rear <br /> 3 <br /> t18.D b <br /> Net Discrepancy Indication Sam ❑ Ouatlty El Type ❑Read, ❑P'mw RePaw ❑Pull Rection <br /> What Reference Number: <br /> 181a.Alternate Facility(a Generator) U.S.EPA ID Number <br /> V <br /> Fadllty'e Phone: <br /> 18c.Ill ofAmmats 10y(orGenerator) MOO Day Year <br /> Q <br /> 2 <br /> 19,Haxa*w Msle Report Management Method Codes(i.e.,codes for hazardous vmata recurrent.dispoael.and mcydi g systema) <br /> � 1. ISA 2. 3. 4. <br /> 20.. ..ty Omer tor` to CeNficwfl of receipt ofN rdous matedela covered by the ma platin in Rom 19A <br /> n a gnafure comm Day year <br /> Epp1O(% 1p <br /> usedin <br /> ipp a are obsolete. ATIONSTATE(IF REQUIRED) <br /> 73704O79 <br />