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SSL SK SHIP# 230941068 111111111111111111111111111111111111111111 <br /> 0 0 7 4 3 9 0 7 9 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.Emer g Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST CAL000327839 1 1Oft1-468-1760S <br /> SK <br /> 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) SKS <br /> Les Schwab Tire Center 673 <br /> 1717 W Charter Way <br /> STOCKTON CA 95206-1114 <br /> Generator's Phone: 805"438-5487 <br /> 6.Trans orter 1 Com any Name U.S.EPA ID Number <br /> 9 FETYLEEN 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 U.S.EPA ID Number <br /> CLEAN HARBORS ARAGONITE, L.LC <br /> 11600 NORTH APTUS ROAD <br /> Facility's Phone: ARAGONITE , UT 84029 <br /> 435-884-8100 UTD981552177 <br /> ga. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit <br /> HM and PeAng Group(if any)) <br /> No. Type Quanfity WLNoI. 13.Waste Codes <br /> 1. NON RCRA HAZARDOUS WASTE LIQUIDS r DM —7r P 343 <br /> YCOL ETHER, WATER), 4144 <br /> w <br /> Z 2. <br /> w <br /> A <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional Information TSD AG 8522503 LE 15361 hhC <br /> 24H EMERGENCY - - _ _ <br /> #800 468 1760 CH/SK/TFI Contract retained by generator confers a e y c authoriy <br /> an initial kra n � <br /> h;41 f- <br /> 15. GENERATOR'SIOFFEROR'S CE FICATION: 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 EPAAcknowledgment 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)(if I am a sm anfity generator)is true. <br /> General s/Offerors Printed/Typed Name signal ur Month Day Year <br /> �Al1A ?0 <br /> ,j 16.Interhational Shipments -Av �� <br /> H ❑Import to U.S. ❑Export from U.S. Port of entry/exit: <br /> 9 Transporter signature(for exports only): Date leaving U.S.: <br /> W 17.TranspoderArknqwleqgpe)t of Receipt of Materials <br /> T 0 <br /> sporter 1 Printed,/�yp� 'me Signa Month Day Year <br /> co VVI 3 �d iR <br /> [Transporte�r­2PrinedTypedName Signa re t Month Daly Year <br /> ~ 03 2 LQ <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ quantity ❑ <br /> Type EJ Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Refe <br /> 18b.Alternate Facility(or Generator) rence Number: U.S.EPA ID Number <br /> J <br /> U <br /> LL Facility's Phone: <br /> La 18c.Signature of Altemate 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 HWO 2. 3 <br /> 4. <br /> 20.Designated Facilityner o Operator:Certification of receipt of h rdous materials covered by the manifest except as noted in Item 18a <br /> Printed/Typed Name Signature Month D Year <br /> L % <br /> EPA Form 8799 ev.12-17) Previou a itions are obsolete. DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM <br /> 1)7609977/1018861 <br />