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SSL SK SHIfi'N axe ''�°�4; (T <br /> P lease print or type.(Form designed for use on elite(1 2-pitch)typewriter.) Form Approved.OMB No.2050-0039. <br /> UNIFORMHAZARDOUS 1.Generator ID Number _ 1 2 P 1 of 3 E cY a ref d.Manifest Trecking Number <br /> CA098I9676d 1 Ar.-. g' <br /> 1 age. ^ <br /> WASTE MANIFEnd : �` 1 t , 7 0 ACA SKS KS <br /> 5.Generators Name and MadmgAdtress 'Gammtors.SitaAdmess(if different than mailingaddress) �7 J.�7 \71�u <br /> att'iCktnn DAdu]E'.. <br /> 3333 Auto Center Cin <br /> STOCKTON CA 99212-2637 <br /> Generators <br /> ePhone: <br /> op�a��y'�41-"000--aOOd <br /> _ 6.T RttI Y^iSA:ttd4e SYSTEMS, INC. U.S.EPA ID Number axR?V131f1d:'Oj <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> B.Designated Facility Name and one Address CLEAN <br /> HARBORS OF WILMINGTON LLC. U.S.E AI umbe <br /> 1737 EAST' DENNI STREET <br /> WILMINGTON CA 90744310-8^35-9998 :Fat 0444,98't5 <br /> Faalrt/s Phone: r . _ <br /> ga 9b.U.S,DOT Description(including Proper Shipping Name,Haunt Class ID Number, 10.Combat are 11 Tout 12.Unit <br /> HM and Packing Group(I any)) No. Type Quantity Wt.Nol, 13.Waste Codes <br /> i 1 NON-:RCRA HAZAROOi3S WASTE, SOLID 7",% + , <br /> (OIL FTI.TERS? <br /> W. 2 <br /> 0 <br /> 3 <br /> a <br /> 14.Special Handing lnshoctionsand Additional lnfarmafion ISO:Wt' 71450966 ST 139 201641 CFS6 23 <br /> 24 HR EMERGENCY # 8110-488-1760(SAFETY-KLEEN: ! c r <br /> A11TH AS "AC�ENT-FORn 8Y GEN TO R .i-AIN'' L.ICEtSE 1t +CAPP ER011- ASNECESSARY <br /> 15. GENERATOR'SIUFFEROR'SCERTIFICATION: Thereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, <br /> marked and labeledlplacarded,and am in all respects in proper condition for transport according to applicable international and national governmental regulations.If export shipment and I am the Primary <br /> Exporter,I cerdly that the contents of this consignment conform to the terms of the attached EPAAcknowledgmentof Consent. <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)(t I am alarge quantity generator)or(b)(tI am a small quantity generator)is true. <br /> Generatoes/Offemes P tedlTypedName. Signature <br /> \ f . g _ . . Monti -Day Year <br /> be6.International Shipments <br /> Z. ❑Import to U.S. ❑Export from U.S - -Parr.of.eoay/aXl(; <br /> Transporter signature.(for exports omy): - Date leaving U.S.: f <br /> W 17.TransporterAcknowledgment of Receipt of Materials <br /> �.Transporter l Printed/Typed Name <br /> ;SgnaWre . / Monts Day IL Year <br /> I ID <br /> T r 2 PnntetRy d Name m �'L.� .�-T� Month t4 <br /> Year <br /> t— Ile / l <br /> r111.Discrepancy ! ! <br /> 18a.Discrepancy Indication Space ❑ quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number: - <br /> 180.Alternate Facility(or Gerrerator) U.S.EPA ID Number <br /> LL <br /> Facility's Phone: <br /> W 18c.Signature of Alternate Facility(or Generator) ' <br /> Month Day Year <br /> z - <br /> w19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 20.Designated Fac&y Omer or Operator Certification of receipt of haurdous materials covered by the manifest wompt as noted in Item i8a <br /> VIII Prinmd/iyped Name I <br /> re Th Day Year <br /> T <br /> t <br /> EPA Form 8700-22(Rev.3.OS Previous fo <br /> ouSetlitionsareobsolete. DESIGNATED FACILITY TO GENERATOIT-",y., <br /> 4: <br />