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1� SSL SK SHIP# 225154295 IIIIIIIIIIIIIIIIIIIIIIIIIIIIillllllll <br /> l 0065139195 KS <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.Emergency Response Phone 4.Manliest Tracking Number <br /> WASTE MANIFEST CALM346561 1-800-468-1760 006513919 SKS <br /> 5.Generators Name and Mailing Address Generator's Site Address(if different than mailing address) <br /> TCI Leasing & Rentals <br /> 2150 W Charter Way <br /> STOCKTON CA 95206-111 <br /> Generators Phone: 209-941-4034 <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> SAFETY-KLEEN SYSTEMS INC TXR000081205 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> CLEAN HARBORS ENVIRONMENTAL SVC INC. MAD039322250 <br /> 8.Designated Facility Name and Site Address CLEAN HARBORS GRASSY MOUNTAIN U.S.EPA ID Number <br /> 3 MILES EAST, 7 MILES NORTH KNOLLS EXIT 41, OFF I-80 <br /> KNOLLS , UT 84083 <br /> FadliVs phone: 435-884-8915 1UTD991391748 <br /> ga 9b.U.S.DOT Descriplion{induding Proper 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 Wt./vol. <br /> 1. <br /> *&W-. NON--RCRA HAZARDOUS WASTE, SOLIDS DM (� P 352 <br /> (OL, DIRT, SAND, ABSORBENTS AND pf43`' <br /> bIESEL FUEL), IWM Atri <br /> z z. <br /> Ulu-c� <br /> TKTH <br /> �+► <br /> yN81� NEM RCRA HAZARDOUS WASTE SOLIDS, DM P 352 <br /> (GREhSE), -Nfi*F3,, <br /> i <br /> 4, RNM WASTE ' <br /> 14.Specht Handling Instru ns and Additional Irformalior TSD.-SM 76552866 TC 10591 CSG: <br /> 24 HR EMERGENCY #1-800-468-1760 (CH / SK / TFI) 60 <br /> 15. NE 0 'SOF 91 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, <br /> marked and labeled/placarded,and are in all respects in proper condifion for transport according to applicable international and national govemmental regulations.If export shipment and I am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. <br /> I oe*that the waste m'lnimizabon statement identified in 40 GFR 262.27(a){if I am a large quantity generator}or(b)(ill am a small quantity generator)is true. <br /> Generator'slOffe rinted/T ed Name Signature r Month Day Year <br /> 16.Inte I Shipments Ir <br /> F. 1:1 Import to U.S. Export frau U.S. rt of entry/exit: <br /> = Trans her signature(for exports only): Date leaving U.S., <br /> W <br /> 17.Transporter Acknowledgment of Receipt of Mall <br /> Tres rter 1 PrintedIM,ped ame Signa Month DayyearYear <br /> 0 <br /> a jq J <br /> QTransporter 2 PrintedlT me Signa Month Day Year <br /> d g <br /> 18.Discrepancy <br /> 19a.Disueparlcy Indication Space ❑ Quantity ❑Type ❑Residue ' ❑Partial Reject. ❑Full Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> V <br /> Facility's Phone: <br /> W 18c.Signature of Alternate Fadlity(or Generator) Month Day Year <br /> a <br /> z <br /> 1 <br /> 19.Hazardotis Waste Report Management Method Codes(i.e..codes for hazardous waste treatment,disposal,and recycling systems) <br /> as <br /> G t' 2. 3 4 <br /> 20.Desi naiad Facilityer or Operates:Gertifioation of receipt of hazardous materials covered by the manifest a pias nested in I m <br /> Printed!( am n Signature th6 <br /> a <br /> f <br /> EPA Form 8700-22(Rev. -0Previous editions are obsolete. DESIGNATED F I I O DESTINATION STATE(IF REQUIRED) <br /> 1)8256200/1630085 T 3)8256201/1630137- <br />