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SSL SK SHIP#'22t�t5T3- tI1111N11111l1{N1lf1taHim,o..a <br /> Z��j�1 0070400S6SK8 <br /> Z <br /> Form Approved.OMB No.205fl-Q039 <br /> --._PSI ase tint or <br /> UNIFORM HAZARDOUS 1.Generator t7um60f -- 3 Em en Response P 4.Manifest Tracking Number <br /> WASTE MANIFEST CAL0000879820 =488=- 5�-- <br /> 5.Generators Name and Mailing Address Generators Site Address(tf different Than mailing address) <br /> San I Pak Inc <br /> 23535 S BIRD RD <br /> TRACY CA 95376-0000 <br /> Generators Phone:- 209-835-3104 <br /> U-S.EPA 10 t4tanber T X 8000081205 <br /> s.TrgsQod@L 9rnpg t` gEA SYSTEMS INC <br /> 7.Transporter C`o—m5Wy Na.— U.S.EPA ID Number <br /> CLEAN HARBORS ENVIRONMENTAL SVC INC. MAD039322250 <br /> 8,Designated Facitity Name and Site Address CLEAN HARBORS ARAGONITE, LLC U.S.EPA ID Number <br /> 11600 NORTH APTUS ROAD <br /> 435-884-6100 RRAGONITE , UT 84029 UTD981552177 <br /> Fac qty's Phone: <br /> 9a 9b,U.S.DOT Description(including Proper Shipping Name,hazard Class,ID Number, 10.Containers 11 Total 12 Una 13 Waste Codes <br /> HM and Packing Group(if any)) No. Type Quantity WLN i. <br /> X ' UN1325 WASTE FLAMMABLE SOLIDS DM P F00 F00 D001 <br /> o ORGANIE, NA-S- ,S. , (ACETONE, TOLbENE�, <br /> 9 4. 1, PG I I 352 <br /> Z 2. <br /> w <br /> O <br /> 3. <br /> 4, <br /> 14.Special Handling Inslrucl c is and Addibonal Information TSD-.AG 79688085 SA23574 <br /> 1)ERG#133• V /` <br /> 24H EMERGENCY#800-468-1760—CH/SKITFI—Contract retained by generator confers a enly authori y <br /> 15. GENERATOR'WFFEROR'S CER FiCATION: I hereby declare that the contents of this consignment are fully and accurately described abGve by the proper shipping name,are are classified,packaged, <br /> marked and labeled/placarded.and are m all respects in proper condition for transport according to applicable intematonal and national governmental regulations.If export shipment and I am the Primary <br /> Exporter,I certify that the contents of this consignment cmforrn to the terms of the attached EPA Aduwwledgfi5errt d Consent <br /> - <br /> I that the waste minimization statement identified in 40 CFR 26217(a){if l am a large quantity generaW or(b)Cif I am a snap quantify generator)is true. <br /> "Typed Name r Signature mar* Day Year <br /> G�-�;P;lc- <br /> 16.International Shipments <br /> F ❑import to U.S. Export from U.S. Porto(entryfexit_ <br /> ? Transporter signature(for exports only): Date leaving U.S.: <br /> CC 17.TransporterAdmoxAedgment of Receipt of Materials <br /> n 1 Pnnted/Typed N galore Month Day Year <br /> O <br /> Z ransport r ntad/Typ me - Month Day Year <br /> C� z <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space Quantity Type ❑Residue ❑Partial Rejection ❑Fun Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or or) U.S.EPA ID Number <br /> J <br /> U <br /> ra+_ Facility's Phone'. <br /> W 18c.Signature of Alternate Facitity(or Generator} Mon h Day Year <br /> Q <br /> Z <br /> 19.Hazardous Waste Repogt anagement Method Codes(re.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> w 1 2. 3. 4 <br /> o � u <br /> 29.D ted Facf;ty Owner or Operator.Certification of receipt of hazardous materials covered by the manifest except as ruled in Item 18a <br /> Pnnted�TyRed Name is tun Month iDay Year <br /> 1 <br /> EPA Form 00-22 ev 12- ) Previous editions are obsolete. DESIGNATED FACILIT TO EPA's e-MANIFEST SYSTEM <br /> 1)83668%/1554826 <br />