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SQL SK SH)'1 r1# <br /> / t Do 0 :440 it <br /> Please print or type. `s5 b� !C Form Approved.OMB No,2050.0033 <br /> UNIFORM HAZARDOUS 1 1.Generator ID Number 2.P o 1 3. me R s pg!.P4,Manifest Trackin Num er <br /> tstll_�+48 - - � �>a1006960044 SKS <br /> WASTE MANIFEST <br /> 5.Generator's Name and Mating Address Genomtoes SileAddross(if different than mailing address) <br /> ttrr rn r ui.rt Co Maintenance <br /> 1810 E F�.azelt;on Ave <br /> STOCKTON CA 95205_60$21 <br /> Ganarator'sPhone: R -468•-3099 <br /> 6.Tr p y U.S,EPA 10 Num w <br /> "ROS r rt>ppA�� SYSTEMS INC T X R121�t008 i-05 <br /> I.Transporter 2 Company Name U.S.EPA ID Number <br /> CLEAN HARBORS ENVIPONM NTAL. SVC INC. <br /> 8.DesignatedFatililyName and Site AddressCLEAN HARBORS E:NVIRU)IdI�"FNTAL SERVICES, IN <br /> U.S.EFAIDNumber <br /> C247 5 14I GHWAY -71 <br /> KIMP€)Li_ , NF 69145 <br /> ,,C�B� ;s,w417i1 NED9917 3513 <br /> Faot s Phone: <br /> ga. 9b.U.SCOT Description{ndudProper Shipping Name,HaClass,ID Number, 10.Containers <br /> 11.Total 12.Unit <br /> 13,Waste Codes <br /> HM and Packing GrcuP(if <br /> any)) No. Type <br /> WLAof <br /> 7 <br /> F, s� <br /> NON RC HA..ARI7C]'`S AS t" LIQUIDS <br /> r,,� s4 -- <br /> �� RA 4J �� . ! I r14� IZN t' s�'1�% <br /> a <br /> (ME(SEU, <br /> ga <br /> Z 2. <br />{ 3. <br /> f <br /> 4. <br /> l <br /> 14.Special Handling Instructions and Additional lnfomration TSD;KP 80170 07 SF 32680 CSC <br /> '"4H EMENGE'NCY#800-468--i760-•-CHI SK/TFI—Cant riic.t r8tained by gene lAtor confers a engV-aikthriri y <br /> r _ r [InaS s . <br /> 15. GENERATOR'SfOFFEROR'S CERTIFICATION: I hereby declare that the contents of INS consignment are linty and aeeutato)y described above by the proper shipping name,and are dassifled,packaged, <br /> marked and labeledlplacarded,and are in all respects in proper condition for transport according to applicable International and nalional governmental regulations.If export shipment and I am the Primary <br /> Exporter,l certify that the conlenis of this consignment conform to the terms of the attached EPAAcknowledgment of Consent <br /> I certify that the wasle minimization slatement tdenWad in 40 CFR 262.271a)(61 aro a large quantity generator)or(b)(if I am a small quantity,gene(ator)is(too, <br /> E Generat0r's10€feroi8 Printedl3yped Name Signa ore .,, Month Oa Year <br /> I <br /> ,,,,t 16.Intemationat Shipments r� <br /> ❑import to U.S. ❑Exporl from U.S. Port of enimlexil: <br /> Transporter signature(for exporls only): Date leaving U.S.: <br /> ce 17.TranspoderAc4now44rnerdofRaceiptolMalerials <br /> Tra or 1 Printed ed Name Signature Month Da Year <br /> E a �. C 2sL'�-( ' (D <br /> N Tr n er rinntteddlTyped Name Signa Month Day Ye <br /> c 18.Disuepancy <br /> 18a.Dlscmpancy Indication Space Ovanlily ❑Ty" ❑Residue ❑Partial Rejection <br /> EJ Full Rejection <br /> Manifest Reference Number. <br /> 18b.Allamate Facllily(or Generator) U.S.EPA ID Number <br /> a <br />' Facility's Phone: <br /> 18c,Signature of Alternate Facility(or Generator) Month Day Year <br /> d <br /> a <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,andrecycliog systems) <br /> 1. 2. 3. 4. <br /> lir I 20.Designated Facility Owner or Operator:Cerflfication of receipt of hazardous materials covered by the manifest except as mated in Item 18a <br /> ' Pdnledlfyped Name a u oath DWy Ye r <br /> —71 <br /> j EPA Form 8700.22 JRev.12-17) P ylous editions are obsolete. SIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM <br /> 1) I3EQ1592 19r_8:-r ',1 <br />