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SSL SK SHIP# 229875442 1111111111111111111111111111111111111111111 <br /> 0 0 7 3 1 4 0 7 3 S K 3 <br /> Please print or type. Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Pa e 1 of 3. med0 6 R spoil e Phi 4.Manifest Tracking Number <br /> WASTE MANIFEST CAL0003c7839 g —tl��P— btl-1!�{� 007314073 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 9506-1114 <br /> Generator's Phone: 805-438-5487 <br /> 6.TrgFrjef or 4�ny-l� R SYSTEMS INC U.S.EPA ID Number T X R000081205 <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 /> 435-884-8100 <br /> Facility's Phone: <br /> ga 91b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10,Containers 11.Total 12.Unit <br /> HM and Packing Group(if any)) No. Type Quantity wt.Vol. 13.Waste Codes <br /> U <br /> F. — <br /> a <br /> w <br /> ZNON RGRA HAZARDOUS WASTE- LIQUIDS DM f/y P 343 <br /> (GLYCOL ETHER, WATER), ft/fr <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional Information TSD:AG 81535272 LE 15361 <br /> 24H EMERGENCY#800-468-1760—CHISK/TFI—Contract retained b� generator confers a ency authori y <br /> on initial transporter to add or substitute additional transporters on genera or' s 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 conAt of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. <br /> I certify that the waste minirgi statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a sma quant/, e ator)is true. <br /> Generators/ s Vrin d ed m Signature Month Day Year <br /> _J 16.Intern <br /> ❑Import to U.S. ❑Export from U. Port of entry/exit: _ <br /> ? Transporter signature(for exports only): Date leaving U.S.: <br /> rY 17,,,JLansjp6i1erAcknowledgment of Receipt of Materials <br /> w <br /> w Tr s rter 1 Printed ff ame Signatur Month Day Year <br /> a <br /> N7 2 Pri ed T ed Name <br /> _yP Sign Mon Day Year <br /> — t� _ t l <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space Ll <br /> Quantify El Type ❑Residue ❑Partial Rej n Ll Full Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J_ <br /> U <br /> u- Facility's Phone: <br /> L01 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> Q <br /> Z <br /> N19,Hazardous Waste Report Management Method Codes(i.e..codes for hazardous waste treatment,disposal,and recycling systems) <br /> 0 1T <br /> 3. s ,;. 4. <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> PrintedlTy ed Na SigauMonth <br /> Zonth a Year <br /> 1 r � � l <br /> EPA Form 8700-22(Rev..12-17) Previous editions are obsolete. DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM <br /> 2)7879709/1325356 <br /> Q&4 <br />