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0067777103KS <br /> Form Approved.OMB No.2050-0039 <br /> Please print or type. 4.Manifestng Number <br /> 1.Generator ID Number 2.Pageat of 3. m R s e P 000771110 SKS <br /> UNIFORM HAZARDOUS PAI-0001 2-711331.3 C^?�� ����-���' 1 � <br /> WASTE MANIFEST <br /> 5.Generator's Name and Mailin Address Generator's SiteAddress(if ddferent than mailing address) <br /> Les Schwab lire Center 673 <br /> 1717 A Charter Way CA 95206-1114 <br /> STOCKTON <br /> 805-438-5497 <br /> Generator's Phone: U.S.EPA ID Number T X R000,0E1.Pf1 5 <br /> s.Tr�Itfro SYSTEMS INC <br /> U.S.EPA ID Number <br /> 7.Transporter2Com an Name N.AItf�3332��;"-��� <br /> CLEAN Go- ENVIRONMENTAL SVC INC. <br /> 8.Designated Facility Name and Site Address <br /> (-L-EAN HARBORS E.L. DO01110, L.LC U.S.EPA to Number <br /> 309 AMERICAN CIRCLE <br /> EL. DORADO v AR 71730 ARD0697413192 <br /> 870-8F3-7173 <br /> Facility's Phone: <br /> 9b.U.S.DOT Description(including Proper Shipping NameNo,Hazard Class,ID Number, Containers Total 12.Unit 13.Waste Codes <br /> 9a. No Type Qu Quantity Wt.Nol. <br /> HM and Packing Group(If any)) <br /> � X 1. RCS LN1g50, WASTE AEROSOLS, (EAC`? NOT � DM �� <br /> P Dk4�1 D�a,v, D!11-.A <br /> o EX EEDING 1 L CAPACITY), c'.1 (DO101) D00 i)OttP: 33l <br /> Z 2. <br /> Lu <br /> t7 <br /> 3. <br /> 4. <br /> F14.SpecaiHimdling Instructions and Additional Information TSD;EL 7784965S' L'`---1�a'�3 i CUFF <br /> 114LV� � <br /> S)ERG#R12n Y <br /> 24H EMERr 'NCY#�S00-4E.8-17CO-CHr'SF'TET.--C.ontract retained by generator confers, ar}ency a lthori <br /> on initial transf arter to add or sr3bstiti_ite ;additiOP-01 trary cr•ters on anerator's behalf. <br /> 15. GENERATOR'SIOFFEROR'SCERTIFICATION:Thereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,aid are dassifiad,packaged, <br /> marked and IabeledlplacardecOrid are in all respects in proper condition for transport according to applicable inlemafional and national govemmen ulattons.If export shipment and am the Pdmary <br /> Exporter,I certify that the wnterits of this consignment conform to the terms of the attached EFAAcknowledgment of Consent.am a small rotor)is true. <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(' .Month Day Year <br /> Generator'sl0ffemrs PrinledlTyped Name <br /> Signature <br /> Ina tt i3u <br /> 16.International Shipments LI Import to U.S. ❑Export from US, Port of entrylexit: <br /> r Date leaving U.S.: <br /> z Transporter signature(for exports only}: <br /> K 17,TfansporlerAcknowledgmentof Receipt of Materials Month Day Year <br /> F- Tran d 1 Printedrrype me `/fes' SignalI <br /> 13- T Signature Month Day Year <br /> Z Transpo k2 Pri dlryped Name !� <br /> 18.Discrepancy <br /> 16a.Discrepancy Indication Space � Quantity El Type <br /> ElResidue ❑Partial Rejection FA Rejection <br /> Manifest Reference Number. <br /> U.S.EPA ID Number <br /> r 186.Alternate Facility(or Generator) <br /> J <br /> aMonth Day Year <br /> u- Facility's Phone: <br /> w 18c.Signature cf Altemate Facility(or Generator) <br /> Q <br /> M <br /> 00 <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems 4 <br /> LU 2. 3. <br /> ' I-loUo <br /> 20,Designated Facility Owner or Operator.Certification of receipt of hazardous materials covered by the manap; <br /> Month Day Year <br /> PrintedRypetl Name orte dNa g. Pviouseditionsareobsolete. TOEPA'Se-MANIFESTSYSTEM <br />