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lfl�i (I It 11111iNINin n Jill 5t„ 1t1 <br /> c�ciL ✓l; SHT �r# 8211�`'..3r444d 0 0 7 0 4 4 3d, 7 8 K S <br /> Form Approved, OMB No. 2050 0039 <br /> Piesse print or type. Lmd <br /> nifest Tracking Number � +1. Generator lD Number 2. Page 1 of 3. Emer�ey Re�s2o9Fe Phggg,�h 0 7 04032 ? iVUNIFORW14)VARDOUS Cfll}9E323 f� 1 r1 1 tS Y1 bFt 1ltWASTE MAN{FEST Generator's Site Address (if d'dferam than afling address} <br /> 5. Generator's Name and Mating Address g I n C_ . <br /> Mrfrra Trailers <br /> Di � i << i. esn of Nos an Mfg . , <br /> 1754 K . Mariposa Road CA 55205-7750 <br /> ST009TLlN <br /> Generatofs Phone: " 'xWNW <br /> 09-83 "•7323 WIN U.S. EPA ID Number <br /> 6. Trans a Com ny m <br /> `l } Y" LE <br /> SYSTEMS INC u.s. EPAiDNumoar <br /> 7. Transporter 2 Company Name <br /> f L FAN HARBORS EWVIRONMENTAI.- SVC OWN INC < UIIIIIIIIIIIII .S. EPA ID Number <br /> 6, Designated Facility Name and Site Address ' CLEAN HARBORS ARAGONIfI � <br /> 11600 NORTH ARTUS ROAD } LIT t,i l l�9.�t15�i 177 <br /> ARAGONITE <br /> Facxit s Phone: 10. Containers 11 , Tota) 12. Unit 13. Waste Codes <br /> 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, Q. entity Wt.Nol• <br /> 9a. No, Type <br /> HM and Pecking Group (if any)) DIM � R 52 <br /> NON- RGRA HAZARDOUS WAST SO)JD , (} <br /> F WAII1T BOOTH FIL_TFR ) , tot �, J <br /> z 2. <br /> LU <br /> 11 "Will NO <br /> 3. <br /> 4. <br /> 78096&4. MU1. 7758 CSG <br /> 14: special Nadling ill UcBons and Additional Information TSD p Ats ) qV d d <br /> genera <br /> confers a envy a1 that^ i y <br /> 24H EMERGENCY#800-458- 1780—GH/ i� ISUI -Guntr act retained b111111 111111 111111t 111111111111 . it o rs ame, and are classified,r ' <br /> n <br /> 15. GENERATOR,s1OFFERO�'aSd aERR etFFll NA�iI f8:hereby decie�ndaion Sorcetra�sport a Iccordingta applicable it to natioan ona and ationnnalely a govemm ntai regulations, It export shipment anabovA by the proper shipping d t am the Pdman/tl <br /> marked and labelediplace ment of Consent. <br /> Expoder, t certify that the contents of this consignment conform to the terms of the attached EPAAclmowiedg r} or (b) (if i am a small quantity generator) is true, ' Mon Da Year " <br /> I certify that Bre waste mtnimization statement Identified In 40 CFR 262.27{a) (if t am a large quality geIII William I IIII nerator) 1y t t <br /> ratoeslofferor's Printedfryped Name <br /> 5 , tics <br /> '16t Into at Shipments Export from U.S. Portof entrylexit <br /> F ❑ Import to U•S. Date leaving <br /> 7M Trabspader signature (for exports only): <br /> Ox 17. TransporferAcknovrledgmntofReceiptofMaterials Month Day Yoar <br /> Signatu A 4� <br /> Tra or 1 Printedff Name 4' <br /> Month Day _ Year <br /> j signature �3p 1l <br /> Trartispo r 2 P ntedlT ame —"'—` <br /> c 18, Discrepancy MINIM ROOM= ❑ Full Rejection <br /> 18a, Discrepancy Indication Space Quantity <br /> Type <br /> ❑ Residue ❑ Partial Rejexwon <br /> i <br /> Manifest Reference Number: Us, EPA ID Number <br /> 18b. Aitemate Facility (or Generator) <br /> J <br /> Month Day Year <br /> Facility s-Fhone: <br /> w 16c. Signature of Alternate facility (or Generator) <br /> 2illiplill WOMEN <br /> ta Report Management Method Codes Q.e., codes for hazardous waste treatment, dsposal, and recycing systems} <br /> 19. Hazardous was4• <br /> 2 3. <br /> n 1 . 0 ! tef� h <br /> vM ay Year <br /> 20. Designated Facility Owner or Operates: CeNfication of receipt of hazardous materials covered by the manifest as end in Item 188 <br /> rI <br /> Printed ped am <br /> s -2 ev 2- sous editions are obsolete. DESIGNATED FACILITY TO EPA's O*MANIFEST SYSTEM <br /> Epi <br /> Fop B 2h( r igig <br /> e _ <br /> I <br />