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SK SHIP# 228574951 <br /> Please print or type. Form Approved.OMB No.2050-0039 <br /> I <br /> 1.Generator ID Number <br /> 11.1a,o..�ol 3, mef�en. Respp.Ap,se Pho 4,Manifest Tracking Number <br /> UNIFORM HAZARDOUS CAL0001b 1 a is —C,V -1l , 13 d <br /> WASTE MANIFEST 1006960044 SKS <br /> 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) <br /> San Joaquin Co Maintenance � <br /> 1610 E Hazelton Ave <br /> STOCKTON CA 95205-6232 I <br /> Generator's Phone: 209-460-3095 <br /> 6.Tr s9N NY,,Com-��'.yEN SYSTEMS INC U.S.EPA 10 Number ! <br /> TXIR000081205 <br /> fl <br /> 7.Transporter 2 Company Name U.S,EPA 10 Number <br /> p Y <br /> CLEAN HARBORS ENVIRONMENTAL SVC <br /> INC. MAIf03432225141 <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number <br /> I <br /> g Y <br /> CLEAN HARBORS ENVIRONMENTAL E 9lr VICE <br /> A RS VVIR N�9 NTAL � ,R r'3 IN <br /> 2247 9 HISHWAY 71 ' <br /> KIMBALL , NE 69145 <br /> 3�dN-2;�a-4012 NED981723513 <br /> Facility's Phone: <br /> ga 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,10 Number, 10.Containers 11.Total 12.Unit 13.Waste Codes <br /> HM and Packing Group(if any)) No. Type Quantity WI.Nol. <br /> ' NON NCM RCRA WZ ARDOLIS WASIF L I OU I DS DM P 343 <br /> o , (DIESEL) , !► ff <br /> W <br /> Z 2. <br /> W <br /> 3. <br /> 4. <br /> 14,Special Handling Instructions and Additional information TSA tt KP 80170R07 SA32580 C361 <br /> 24H EMERSENCY#800-468-1760•-CHISK/TFI-Contract retalried by generator canfers a rn'y atathori y <br /> hp ha I f <br /> 15. GEN ERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described shove 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 applicabfe 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(be 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 small quantity generator)is true. <br /> GeneratDr'SlofferOr'S Printed/Typed Name Signature Month Day Year <br /> j <br /> 16.International Shipments <br /> ❑Import to U.S. ❑Export from U.S. Port of entrylexit: <br /> ? Transporter signature(for exports only): Date leaving U.S.: <br /> W 17.Transporter Acknowledgment of Receipt of Materials <br /> LU <br /> Transporter 1 PrintedlTyped Name Signature Month Day Year <br /> Q <br /> b <br /> Transporter 2 Printed/Typed Name Signature Month Day Year <br /> I' 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑ResidueEl j i <br /> Partial Rejection Full Rejection <br /> Manifest Reference Number: <br /> 18b.Akernate Facility(or Generator) U.S.EPA ID Number <br /> J_ <br />_ U <br /> LL Facility's Phone: <br /> Lu 18c.Signature ofAilemate Facility,(or Generator) Month Day Year <br /> a <br /> Z <br /> 0 1g.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> Q i 2. <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 183 <br /> Printed+Typed Name Signature Month Day Year <br /> EPA Form 8700-22(Rev.12.17) Previous ed!lions are obsolete. GENERATOR'S INITIAL COPY <br /> 1)'7560592/9285-c` <br />