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. SSI . SK SNIP# 22781. 501I. �� IIIItII �� II �'�� II� I� IIIIlIII � I� 0069530966 KI Please print or type, Form Approved . OMB No. 2050-0039 UNIFORM HAZARDOUS 1 . Generator ID Number 7 2. Pa of 3. me RIs Ph"006953096 anifest Tracking Number WASTE MANIFEST r,At_000 f4 617 - - + 1SKS 5 Generator's Name and Mailing Address Generator's Site Address (if different than mailing address) Murray Traj) ers A Division of Hogan Mfg . , Inc: . 1754E Mariposa Road i - � � 066' D C � STOCKTCIN CA 95205 --7790 v Generators Phone: i.:09 -838- 7323 SYSTEMS INC U.S. EPA ID Number F X R> 0147108121715 7. Transporter 2 Company Name U.S. EPA ID Number CLEAN HARBORS ENVIRONMENTAL SVC INC . MADQt3`�32225(� 8. Designated Facility Name and Site Address CLEAN HARBORS ENVIRONMENTAL SERVICES , IN U.S. EPA ID Number 2247 S HIGHWAY 71 KIMBALL , NC 69145 308 - 235 - 4012' KIMBALL 17 Facility's Phone: ga, 9b. U.S. DOT Description (inducting 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 WUVoI. X t ' R01 IIN12631 WASTE PAINT , 3 , PC 11 ( 17005 ) DM \r P F400v 7. FF005 D001. o 'J ,z X 2. UN12631 WASTE FAINT , 31 PG II CF ' ' D001 D005 D �!m r � D007 D008 :' 1. 3. 4. 14 Special Handling Instructions and Additional Information TSD : KP 79434173 MIJ 177 38 CSG e 1 ) ERG## 1cr9 .. ) ERG# 1cEt ok, l0 e 'Z> ' moi 2: 4H EMERG NCY # 800- 4 8- 1760—CH / SK / TFI —Contract retained b generator confers a enc at_tthori. Y 9 � Y � on in nh . ti r a a a 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 labeledlplacarded, 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 EPAAcknowledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a) (if I am a large quantity generator) or (b) Jff I am a small quantity generator) is true. Generator's! Heroes Printed/Typed Name Signature Month Day Year 3 It, International Shipments ❑ Import to U.S. ❑ Export from U.S. Pori of entryJexiC ? Transporter signature (for exports only): Date leaving U.S.: W 17, Transporter Acknowledgment of Reoeipt of Materials } Tr s rter 1 Printe Name Signature Month Day Year CIM th Z Ttarisdad& Minted, Name S' ur Month Day Year 18. Discrepancy 18a. Discrepancy Indication Space i ❑ Quantity ❑ Type ❑ Residue ❑ Partial Rejection ❑ Full Rejection ! Manifest Reference Number: 18b. Alternate Fadlity (or Generator) U.S. EPA ID Number J U ra+ Facility's Phone: W 18c. Signature of Alternate Facility (or Generator) Month Day Year Q Z N19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) 0 1 . 2. 3. 4 . Awn 20, Designated Facility Owner or Operator: Certification of receipt of hazardous materials covered by the manifest exce noted in Item 18a Printed(Typed Name r Signa t _ Month Day YeaL EPA Form 872P 22 Rev. 12-17) Previous editions are obsolete. f 1 61 DESIGNATED FACILIT T EPA's a MANIFEST SYSTEM I ) 11565103 / 1801482 2 ) 8551805 / 1792051