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SSL SK 5H I Pik ease print Or type.jForrrt designed for use on elite(12-pitch)tgpawritec) 6-1 . ForinApprovert OMB Na.2050-0039 UNIFORM HAZARDOUS 1 Generator ID Number 2.Page 1 ofEIE-rnargency Response Phone 4.Manifest Trackin Number WASTE MANfPEST CAR0100083287 1 00-468-17 yt�0 0 61 _3479 $K$ 5.Generators Name and Mailing Address T Generators Site Address(if different than mailing address) Swift Trans nrtatian co 901 )Darcy P�wy LATHROP CA 95330--8754 Generators Phone: 209--858--7:327 -� S.Transporter 1 Company Name U.3.EPA ID Number SAFETY—KLEEN SYSTE14S INC TXR000O 1205 7.Transporter 2 Company Name U.S.EPA ID Number CLEAN HARBORS ENVIRONMENTAL SVC INC. �L I�AD393Ec`. O 8.Designated Facility Name and Site Address CLEAN HARBORS ARASONITE,- LLE' U.f;.EPA ID Number 11500 NORTH APTUS ROAD ARABON):TE , IDT 8409 Facility's Phone: 435-884_8100 llTI398 i 55?177 9a. 9b.U.S.DOT Description(including Pioper Shipping Name,Hazard Class,ID Number, 1q.Containers HM and Packing Group(if any)) 11.Total 12.Unit 13.Waste Godes No. Type Quantity Wt.Nol. X 1'NA3077IfAZARDOLIS WASTE, SOLID, N.O.S. — BM P 0018 3S� (B NZENE), S, PG IIIUJI Z; 5 z 2. - W 4. - 14.Special Handling Instructions and Additional Information - TSt3:AG 75159303 SW10083 CSG: 1)ERG#171• �- 24 HR EMERGENCY #1-800-468--1760 (SK ! TFI) L 15. GENERATOR'SidF EROR 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.It export shipment and I am the Pdmaiy Exporter,I certify that the contents of this emsignment conform to the terms of the attached EPA Acknow edgment of Con TV) I certify that the waste minimization statement identified in 40 CFR 282.27(a)(if I am a large quantity generator}or(b)(if I ail quantity generator)is true. Gene ratorsJOff-N;, rt /Typed Name - Signeture Month Day Year u v� PIN, -j 18.International Shipments Z ❑ImporAo U.S. ❑Export from U.S. P of entrylexit: Transporter signature(for exports only): Date leaving U.S.: W 17.Transporter Acknowledgment of Receipt of Materials - --�---�- Transporter 1 PdntedrTyped Name Srgnalu -"'�-'� ut y Month Day Year QTranspo r 2 Prin Name -- ��—�`- !VLIZ W Signalu Month Day Year 18.Discrepancy '• 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection 1 7-1 Full Rejection _ 18b.Alternate Facility(or Generator) Manifest Reference Number: U.S.EPA ID Number �'- U u Facility's phone: LU 18c.Signature of Wiernate Facility(or Generator) 4 Month Day Year Z 19.Hazardous Waste Report Management Methal Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) O i4. 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manife.f=xcept as not in Item Sa PrintedlTyped Name ! 1gnare M th C/ L L EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY 1)7372557f5021302 - DESTINATION STATE(IF REQUIRED)