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;Sl_ SK SH1P#mak; 1111111111111 N11111111111111111111 <br /> 007313734 $ x$ <br /> Please print or type. Form Approved.OMB No.2050.0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Numbet CAR@00083 R 7 2.Page}of 3, me Respop6e P�ra 4.Manifest Tracking Number SKS e <br /> WASTE MANIFEST +�7 0 07313734 V"V <br /> 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) <br /> Swift Transportation Co <br /> 901 Darcy Pkwy <br /> LATHROP CA 9533@-8764 <br /> Generator's Phone: 209-858-7027 <br /> 6.Tr�a r} y SYSTEMS INC U.S.EPA 10 Number T XROOOOS 1205 <br /> 7.Transppdar 2 Company Name U.S.EPA ID Number <br /> C!_IwAN HARBORS ENV SVC INC. MADQ <br /> 8.Designated Facility Name and Site Address THERMO FLUIDS INC U.S.EPA ID Number <br /> 1.2533 SE CARPENTER DR <br /> 503-798-4616 (�0�t00==--,`.'s;` <br /> Facility's Phone: GLACKAMAS , OR 97015-8988 flR <br /> ga. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes <br /> HM and Packing Group(if any)) No. Type Quantity WtNol, <br /> 1_ NON-RCRA HAZARDOUS WASTE SOLID 'L DM /ZU P ?2, <br /> o (DRAINED/UNDRAINED USED hIL FILTERS) <br /> Qa+ <br /> z <br /> Z. <br /> c� <br /> 3. <br /> 4. <br /> 14.Spacial Handling Instructions and Additional Infonnatwn TSB:TPQ 83703884 SW 100A. v v •J G�L LA <br /> Lk <br /> 24H EMERGENCY#800-468-1760-CH/SK/TFI-Contract retained by genet atot- r_--;1 tens a- envy authors <br /> on initial transporter to add or substitute additional transporters on eneraor's behalf.. <br /> 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, <br /> marked and labeledlplacarded,and are in all respects in proper condition for transport according to applicable intemational 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 the attached EPA Acknowledgment of Consent, <br /> i certify that the waste minimization statement identify in 40 CFR 262.27(a)(if I am a large quantity generator)or(b lriI am a small quaqW generator)is true. <br /> Generatoesl0fferors P'Idol N Signature Month Da Year <br /> �d �l 7p <br /> 16-.Internabonal Shipments <br /> F ❑Import to U.S- ❑Export from U.S. Portof entrylexd: <br /> LE Transporter signature(for exports only): Date leaving U.S.: <br /> tK 17.Transporter Acknowledgment of Receipt of Materials <br /> Transporter 1 ted lfy d Name Signature Month Year <br /> a 20 <br /> Z Trans r2 Printedlryp Name Sign <br /> g Sign re Month Day Year <br /> 18.Discrepancy <br /> 18a.Discrepancy indication Space ❑Quantity ❑Type ❑Rasidue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Fadiny(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> tai Facility's Phone: <br /> 18c.Signature of Altemate Facility(or Generator) Month Day Year <br /> Q <br /> Z <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> UJI 1. � ( 2. 3, 4. <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manife except as d in Ise <br /> PrintedlTyped 1• ,./�+1 Sign re Day Year <br /> W lick <br /> EPA}0 7 67ren <br /> w 12U3Plevious editions are obsolete. SIGNATEO FACILITY TO EPA's it SYSTEM <br />