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Please print or type. =2,7 �-.-10 Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emer enc Response Phone 4.ManifestTracking Number SKS WASTE MANIFEST CAL000�1 45183 1 1--1 0 -4 8-17SO 00695'-11576 V IAV 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) Infra mark 18@45 Kelso Road MOUNTAIN HOUSE CA 95220-OQMO Generator's Phone:' 6.Trans orter 1 Com any Name U.S.EPA ID Number S FE' ',r-til SY5TEMS INC 7.Transporter 2Company Name U.S.EPA ID Number ••{{ VT O� � SVC YNCnCLL[ HARBORS �� k S,Designated Facility Name and Site Address CLEAN HARBORS OF WILMINGTON U.S.EPA ID Number 1737 EAST DENNI STREET �} WILMINGTONx CA 90744 C Facility's Phone: ga 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Glass,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes HM and P ing Group(if any)) No. T Quantity Wt.Nol. 1.-44 w--. �mm RcRA HAZARDOUS WASTE LIQUIDS P tel Fo , 0111L. W/ LESS THAN 10% WATER), 4444-4" i LU 2. ul 0 3. 4, 14.Special Handling instructions and Additional Information T•SD r W 1 79137450 !N40984 D86 ;:.AEMIwRITENCY#800_468 -17GO--CtI/SF,/TFI -Carftract �etaaiyjed by generator confer=� aency ,a�Athnri k;a an init ial transport er t 0 izIldu - add it i onA2 t As r mac. orf a wry- "S b a"IF, 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, marked and labeledlplacarded,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 Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. 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. Generator'slOfferor's Printed/Typed Name Signature Month Day Year 16.International Shipments ❑ ` l 1:1 Import to U.S. Export from U.S. Port of entrylezit: ? Transporter signature([or exports only): Date leaving U.S.: Q� 17.Transporter Acknowledgment of Receipt of Materials w - t2 T porter I Printedlfy d N me Signa Month Day Year Z Transporter 2 Rini Name Signature t Month Day Year ac 18.Discrepancy 18a.Discrepancylndication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection Elull Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number U IL Facility's Phone: Q 1 Br.Signature of Alternate Facility(or Generator)- Month Day Year a 19.Hazardous Waste Report Management Method Codes(i.e„codes for hazardous waste treatment,disposal,and recycling systems) 0 1, 2. 3. 4. 20.Designated Facility Owner or Operator!Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a PrintedlTyped Name Signature Month Day Year EPA Form 8700-22 Rev.12-17) Previous editions are obsolete. GENERATOR'S INITIAL COPY 08537575/17792='05