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SSL SK SHIP# 230423173 11111111111(Illlllllllllllll 81111111 <br /> 0 0 7 2 7 5 0 6 7 S K S <br /> Please print or type. Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Enver enc Res ons!Ph ne 4.Manifest Tracking Number <br /> WASTE MANIFEST CAL000327839 , ! 1-89021'-4�8-160 1007275087 SKS <br /> 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) <br /> Les Schwab Tire Center 673 <br /> 1717 W Charter Way <br /> STOCKTON CA 95206-1114 <br /> Generators Phone: 805-438-5487 <br /> 6.Trans orter 1 Compan Name U.S.EPA ID Number <br /> SAPFETY-KL EN SYSTEMS INC TXR000081205 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> CLEAN HARBORS ENV SVC INC. MAD039322250 <br /> 8.Designated Facility Name and Site Address CLEAN HARBORS ARAGONITE, LLC U.S.EPA ID Number <br /> 11600 NORTH APTUS ROAD <br /> ARAGONITE , UT 84029 <br /> UTD981552177 <br /> 435-884-81210 <br /> Facility's Phone: <br /> ga 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes <br /> HM and Packing Group(if any)) No. Type Quantity Wt.Nol. <br /> 1. N8N@ NON RCRA HAZARDOUS WASTE LIQUIDS DMP 343 <br /> o , (GLYCOL ETHER, WATER), -Wft- � �v <br /> Z 2. <br /> w <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional Information TSD C AG 81983951 LE 15361 CSG; <br /> 24H EMERGENCY#800-468-1760-CH/SK/TFI-Contract retainedby generator confers a ency authori y <br /> __am initial transporter to add or substitute additiona I transporters on r1c; behalf, <br /> 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, <br /> marked and labeled/placarded,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 <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(iy am a small uantity e <br /> General rs/Offero s PrintedlTyped Nar�� � Signature Month Day Year <br /> ,j 16.International Shipments <br /> F- ❑Import to U.S. ❑Export from U.S. Port of entry/exit: <br /> ? Transporter signature(for exports only): Date leaving U.S.: <br /> w 17.Transporter Acknowledgment of Receipt of Materials <br /> T s iter 1 Printed�Fyped Name Signatur Month Day Yar <br /> o <br /> a CTO UNA t l,� <br /> Z Tra�er2 /Typed Name SigMonth Day Year <br /> C1 l <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑Type p El Residue ❑Partial Rejection 1:1 Full Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> v <br /> ;a Facility's Phone: <br /> C3 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> Q <br /> z <br /> H19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> LU <br /> LH0,0 2. 3. 4. <br /> 20.Designated Facility ner I Operator:C rtification of receipt of hazardous materials covered by the manifest except a not in Item 18 <br /> Printed/Typed NamN(440- <br /> Sign Month Day Year <br /> 44 1,201 , <br /> EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM <br /> 1)7679709/1325356 <br />