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SSL SK SHIP# 225505659 �� I �I �� ��I�Ir�I <br /> Please print or type.(Form designed for use on elite(12-pitch writer, Q O t5 5 2 0 T 9 1 3 K 5 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response phone 4.ManNest Trackln Number <br /> WASTE MANIFEST CAR000083287 2- 1-811- S8-1760 '00 <br /> S 5 0 7 91 SKS <br /> 5.Generators Name and Mailing Address Generators Site Address('rf different than mailing address) <br /> Swift Transportation CD <br /> 901 Darcy Pkwy <br /> LATHROPCA 95330-8764 <br /> Generators Phnne: <br /> 6.Transporter 1 Company Name— _ U.S.EPA ID Number <br /> SAFETY-KLEEN SYSTEMS INC TXR000081205 <br /> 7.Transporter 2 Company Name <br /> U.S.EPA ID Number <br /> CLEAN HARBORS ENVIRONMENTAL SVC INC. MA➢0393222541 <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number <br /> CLEAN HARBORS ARRGQNITE, LLC <br /> 11600 NORTH APTUS ROAD <br /> ARAGONITE , UT 84029 <br /> Fadli s Phone: 435-884-8100ARAGONITE <br /> ga. 9b.U.S.DDT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11,Total 12.Unit <br /> HM and Paving Group(ff any)) t No. Type Quantity WLNni13.Waste Codes. <br /> L <br /> o X NA3077 HAZARDOUS WASTE, SOLID, N.O.S. p ➢411 352 <br /> 0 , (BENZENE), 9, PG III <br /> w <br /> z <br /> Z. <br /> w <br /> 3. <br /> 4. <br /> 14.Spacial Handling Instructions and Additional Information <br /> TSD:AG 7£705375 SW10083 CSG; <br /> 1}ERG#171- <br /> 24 HR EMERGENCY #1—AAM-49a-1 XCpf tru_L-SK I—TFT) --_--- <br /> 15. ERA I�F 'S CERTIFICATION:1 hereby declare that the contents of this consignment.are fully and amuratety described above by the proper shipping name,ab are classified,packaged, <br /> marked and labele ftlacarded,and are in all respects in proper condition for transport according to apoicable international and national governmental regulations.tl export ship n>ant and I am the Primary <br /> Exporter,I certiFj that the contents of this consignment conform to the terns of the attached EPAAcknowledgment of Consent. <br /> I certify that the waste minimization staternent identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(dl am a small quand emtor)is <br /> Generator rots Printed/T Name Vie <br /> Month Day Year <br /> IV <br /> r -Z-5-u 16.international Shipments <br /> Z I It <br /> ❑Import to U.S. ❑Export from U.S. Portof enfrylexik <br /> Transporter signature(for exports only): <br /> Dale leaving U.S.: <br /> W17.Transporter Acknowledgment of Receipt of Materials <br /> O Transporter i Printed/Typeda C N <br /> Signature � Month Day <br /> Year <br /> ZQ r P yped Nama <br /> aC (^���j Month Day Y <br /> F <br /> 8.Discrepancy P <br /> 18a.Discrepancy Indication Space ❑Quantity - ❑Type ❑Residue ❑Partial Rejection ❑Full Rejedon <br /> Manifest Reference Number. - <br /> 186.Alternate Facility(or Generator) ILS.EPA ID Number <br /> J <br /> U <br /> LL Facility's Phone: <br /> w l8c.Signature of Allemate Facility(or Generator) <br /> a Month Day Year <br /> z <br /> 0519.Hazardous 1WFays�tee 6V Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 0 1 Y'�7 2 <br /> 3. 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 /> PrintedfTyped Name 'n,.,WI� ��� � Signature - Month Day Year <br /> EPA Form 8700-22(Ree <br /> �1F5)Previous editions areobsotile. 20 l8 <br /> 1}7372255557/500221302 DESIGNATEDFACILITYTODESTINATION STATE(IF REQUIRED) <br />