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55L SK SHIPik-229334275 <br /> PIe2s�bra Y Form A'roved.OMB No.2050-0039 <br /> 1.1146RA HAZARDOUS 1.Generator ID Number 2.Page of 3.IT-e y R�spor Philp 4.Man fes�t]Tot kiSn$,NuQmbbeer (��(c <br /> _ 1NASTE MANIFEST - LAR00 55301 1-CI�O-4tatl'-1 l�ia O 0 i - J O J 6 2 S K S <br /> -6.Generators Name and Mailing Address Generator's Site Address(d different than mailing address) <br /> Tracy Honda <br /> ° TRACY345Auto Plaza Pkwy CA §5376-0000 <br /> Generator's Phone: 805--830-3642 <br /> 6.Trrtganspcga[ffo SYSTEMS INC u.s.EPA ID Namber TXR0000$1205 <br /> 7,Transporter 2 Company Name U.S:' ID Number <br /> c M 30l 2`z 7r <br /> 8.Designated Facility Name and Site Address CLEAN HARBORS EL DORADO, LLC U.S.EPA ID Number <br /> 309 RMERICAN CIRCLE <br /> EL DORADO , AR 71730 <br /> 870-863-7173 ARD069748192 <br /> Facility's Phone: - <br /> 9, 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.containers 11.Total 12.Unit 73.Waste Codes <br /> HM and Packing Group(if any)) No. Type Quantity W.N.I. <br /> a X 1 RG LIN1950 WASTE AEROSOLS, EACH NOT DM P Dft D005 D006 <br /> o EREEDING I L CAPACITY), 2.1 (D001) <br /> 5 D@07 D008 331 <br /> W <br /> z 2. <br /> LU <br /> 3. <br /> 4 <br /> f 14,Special Handling Instructions and AdditionalInformation TSD:EL 80976760 TR34107 Cela: <br /> i)ERB#126• <br /> 241 EMER6MY9800-468-1760-CH/SK/TFI-Contract retained by generator confers a an y authori y <br /> on initialtransporter to--a+id r s stitute addition r <br /> 15. GENERATOWSIIDFFERDWSCERTllN: hereby declare that the contents of this consignment are fully and a=rate€y described above by the proper shipping name,and are classified,packaged, <br /> marked and Iabeledlplacarded,and are in all respects in proper condition for transport according to applicable international and national emmer;�l regulations.If export shipment and I am the Primary <br /> _ Exporter,4 certify that the contents of this consignment conform to the tens of the 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)(i11 am a , uan' general ue. <br /> 4ijAMNei0filienor's Printedrryped Name Signature. M Oay Year <br /> DA i j S.-ra Q- ,-� l "� � � <br /> J 16.rifienration.1 Shipments <br /> F ❑Import to U.S. ❑Export from U.S. Pod of entrylexit: <br /> ? Transporter signature(for exports only): Date leaving U.S.: <br /> W 17.Transporter Acknowledgment of Receiptof Materials - <br /> r i Printed(Typed Name S' „„; Month by Year <br /> Is er-2 Prin _ Name Al Day Year <br /> ' �'TA�Diserepancy <br /> 1 <br /> 18a.Discrepancy Indication Space ❑Quaintly ❑Type ❑Residue ❑PaNal Rejection E]Full Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) - U.S.EPA ID Number <br /> J <br /> f.1 <br /> LL Facility's Phone: <br /> W 18c.Signature of Ntema acility(or Generator) _ Month Day Year <br /> a <br /> z k` <br /> H19.Hazardous Waste Report Management Method Codes(Le.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> G #, 2. 3. 4. <br /> 20.Designated Facility Owner or Operator Certification of receipt of hazardous matenals covered by the manifest except as noted in Item 18a -- <br /> Print yped NameSignature Month Day Year <br /> i4 f 1i <br /> EPA Form 8700-221Rev.12-17 reviouseditionsareobsolete :___:r ` DESIGNATED FACILITY TOGENERATOR <br /> 1)8694712/188 0$ <br />