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SSL SK SHIP# 219979894 _ IIIIIIIIIIIIIINIIIIIIIIIIIIIIIIIIIII <br /> 0 0 5 5 2 1 2 0 3 S K S <br /> Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Ernerq ency Re ase Plane 4.Manifest Tradd Number <br /> WASTE MANIFEST CAD981%768O 1 1-81010-468-1760 0 0 5 5�Z 12 0 3 SKS <br /> 5.Generaars Name and Meiling Address Generators Site Address if different than mailing address) <br /> Stockton Dodge <br /> 3333 Auto Center Cir <br /> STOCKTON CA 95212-2837 <br /> Generators Phone: 441-000-3000 <br /> 6.Tan Her 1 Com n Name U.S.EPA ID Number <br /> SA�ETY-KLEYEN SYSTEMS, INC. TXROOOO812O5 <br /> 7,Transporter 2 Company Name U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address CLEAN HARBORS BUTTONWILLOW, LLC U.S.EPA ID Number <br /> 2500 LOKERN ROAD <br /> Facility's Phone: BUTTONWILLOW , CA 93206 <br /> 661-762-6200 CAD98O675276 <br /> ga 9b.U.S.DOT Desadpfion(including Paper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit <br /> 13.Waste Codes <br /> HM and Packing Group if any)) No. Type Quantity WINd. <br /> 1. NDN-RCRA HAZARDOUS WASTE, SOLID D14 '114 223 <br /> of (OIL FILTERS) V uIkA <br /> z Z. <br /> W <br /> 3. <br /> 4. <br /> 14.Special Handling instructions and AddiOawl Information TSD:BL 71140167 ST37139 M CSG: <br /> 24 HR EMERGENCY #1x800-468-1760 (SK / TFI) 2.5LAW 2'9Q) <br /> 15, GENERATOR'SIOFFEROR'S CERnFICATION: I hereby declare that to contents of this consignment am fully and accurately described above by the proper shipping name,and are classified,Packaged, <br /> marked and IabelecilDWcarded,and are in all respects in proper condition for transport according to appticeble international and national governmental regulations.If export shipment and I am the Prirnary <br /> Exporrer,I certify that the contents of this consignment conform to to terms of the atadhed EPAAcknaMedgmem of giioent. <br /> rtify that the waste minimization statement identified in 40 CFR 262.27(a)if I am a large quantity generator)VAO am a small quantity,w4is we. <br /> eh rsI s Printd7rypd Name 5 /I— lY <br /> = 16.Intema al nE]Import a U.S. <br /> ❑Export <br /> = Pod <br /> Transporer signature(for exports only): SDate on it. <br /> d' 17.TranspaarAdaimWdpnenl of Rece ptof Malenals <br /> . T <br /> 1 PdntecVTypd Name SgreWre MwIll <br /> AV Day Yea <br /> Tans 2Pdn yped Name Signature Month Day Year <br /> 18.Disaepancy <br /> fila.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejeclan <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> Facililys Ph": <br /> 18c.Signature ofAtemale Facility(or Generator) Month Day Year <br /> a <br /> z <br /> y19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> Hi32 <br /> 20.Designated Facility 0ii ar or Opeabr.Certification of receipt of hazardous materials cummil by the manifest except as nded in tem file <br /> 1 P ntedrFyped Name ����Y Signear <br /> abine Month Day Y <br /> CA x4 101?IZ5 Ilia <br /> El)F76172003(/156566 wousedNon reobsolete. DESIGNATED FACILITY TO DES NATION STATE(IF REQUIRED) <br />