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t� SSL SK SHIP#-e7ff <br /> .3 C3 0061007255 KS <br /> Please print or type,(Form designed for use on elite(12-pitch)typewriter.) - Form Approved.OMB No.2050.0039 <br /> UNIFORM HAZARDOUS I.Generator ID Number 2 Pa e 1 of a cyfRkggs 4.ManifestTroaing Number <br /> WASTE MANIFEST CAL®00025554 — 4b� 006100725 SKS <br /> S.Generators Name end Malling Address Gonarator's Site Address(if ditamid than mailing address) <br /> Lodi Honda <br /> 1700 S Cherokee Ln <br /> LODI CA 95240-7802 <br /> G,,,mtors phcne: 559-443-5427 <br /> 6.Tran rterl Com n Name U.S.EPAID Number <br /> SA ETY—K1�E N SYSTEMS INC TXROZOOB1205 <br /> 7.Transporter Company Name - U.S.EPA ID Number <br /> CLEAN HARBORS ENVIRONMENTAL SERVICES INC MAD039322250 <br /> 8.Designated Facility Name and Site Address CLEAW HARBORS GRASSY MOUNTAIN- U.S.EPA ID Number ' <br /> 3 MILES EAST,- 7 MILES NORTH .'KNOLLS.EXIT 41, OFF I-80 0 <br /> ARAGONITE , UT 84029 <br /> 435-884-8915 o IJTD991301748 <br /> Facility's Phorm: - - - -- <br /> ga 9b.U.S.DOT Description(inctudtng Proper Shipping Name,Hazard Class,ID Number, - 10.Containers - 11.Total 12.Unit t <br /> and Packing Group(if any)) - Ouan WtA.'91. 13.Waste Codes <br /> HM n9 P� Y) No. TY�.. �� <br /> X TNA3077 HAZARDOUS WASTE SOLID, N.O,S. t DM ; P D005 007 008 1 <br /> o , (CHRbMIUM, LEAD), 9, �G III <br /> 141 <br /> U, 2. <br /> to <br /> � r <br /> t <br /> 4 <br /> a <br /> { r <br /> 14.Special Handling instructions and Additional Information TSD::6'M 74048891 L024049 CSG: <br /> 1)ERI <br /> 24 HRR EME EME�tGENCY #1-800-46B=1760 (5K /'TFI) ` <br /> SEE ATTACHMENT - <br /> 15. GENERATOWSlOFFEROR'S CERTIFICATION:I hereby declare ft the Contents of this colulgNTlent are hdty and accurately described above by the proper shipping name,and are classified,packaged, <br /> Tor"labetedrplacarded,and are In all respects in proper condition for transport acmrdinquis 7pllcable inttrnetioneland national govemmental regulations.If export shipment and I am the Primary ' <br /> Expoi,I cerli(y that the contents of this consignmentconbrm to the tens of the attached EPAAcknowledgment of Consent <br /> I certify that the waste minimization satemera identified in 4D GFR 26227(a)(d I am a large quantity li erWor)or(b)(dl a small quantitygenerim)is true. <br /> Generator or's yped ion .. .. . . ..Signature.. . . nth Day Year <br /> .0 . <br /> 1b.Internal. vpme is I <br /> Z Impart to U.S. ❑Export from tl.8. Paton leaving <br /> U.S. _ <br /> Transporter signature(far exports onty): _ Dale leaving U.S.: <br /> w 17.Tran&porterAcknoWedgrmnt Df ReWptcfhlzteals <br /> porter 1 PriMed/Typed Name .Signature M th Day Year- <br /> P-3 1 <br /> zQ Transparter2 P Name - Signature <br /> Mon Cay Yesr <br /> Cr�1 rte_ 17 1�1 <br /> 18.D'screpancY <br /> ❑- <br /> 18a.Discrepancy thctcafion Space ElQwmtfly ❑ ❑Partial Rejection_ Type: ReSdue Full Rejection <br /> ❑ <br /> Manifest Reference Number: i <br /> 18b.Allemate Facility(or Generator) ... ... .. _ _. ,. . .. U.S.EPA IDNumbe• i <br /> W Fecility+s Ph— <br /> W <br /> ^— <br /> iBc.Signature o(Atiemale Facility(or Generator) .._ _.... .. .. .. .:.. �-...... Month Day Year <br /> a 1 Z ; <br /> �.19.Hazardous Waste Report Management Meawd Codes(.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> p 1. <br /> r i <br /> 20.Desigrhated FatiGty 0wner or Operator.Codification of recelpt of hazardous materials covared by theman xcept as rlcted kh tem 1 j;. I <br /> PtlntedrfYPbe Nanre Sg atu Month Day Year <br /> D, t <br /> EPAFom87 -22(Rev.'-051 Pevious.editionsareobsolete: D TED FACILITY TO DESTINATION STATE IF REGUH3ED <br /> 1)7572239/944499 {. <br />