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SSL SK SHIP# 232652343 IIINI �III'�I�NII��III� <br /> 007756963 & .& <br /> Please print or type. Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number CAR000225557 2.Pegei of 3.Emeyg y RVsQPJe P.I 4.MantMt TrxMrg Number <br /> WASTE MANIFEST 1 tlrOrO btl 1/6 007758983 KS <br /> 5.Generalds Name and Mailing Address Generators Site Address(8 diderent den mailing address) <br /> YRC Freight 813 / G36 <br /> 1535 E Pescadero Ave APG36EM2 <br /> TRACY CA 95304-8501 <br /> Generators Phone: 209-833-1580 <br /> 6.Trppsf!ffiC.l.QorrpAny Nag B SYSTEMS I NC U.S.EPA ID Number TX ROOOOS 1205 <br /> 7.Traanssoo'rtter�2YCoomtppannyy Nam U.S.EPA ID Number <br /> CLEAN HARBORS ENV SVC INC. MAD039322250 <br /> 8.Designated Facility Name and Site Address CLEANHARBORS OF BUTTONWILL.OW U.S.EPA ID Number <br /> 2500 LOKERN ROAD <br /> BUTTONWILLOW , CA 93206 <br /> 661-762-6200 CAD980675276 <br /> Facility's Plane: <br /> 9a 9b.U.S.DOT Description(including Pmgx Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Godes <br /> HM and PaddniGroup(dany)) No. Type Quantity WWol. <br /> X 1NA3077 HAZARDOUS o WASTE, SOLID N.0.S. DM 2� P D00 D005 DO06(BARIUM CHROMIUM), 9, PG III, O.S. <br /> SHAVINGS) D007 D008 181 <br /> z z. <br /> W <br /> f� <br /> 3. <br /> 4, <br /> 14.Special Handling Instructions and Additional Information TSD:BL 84528811 YR00059 <br /> 1)ERG#171• <br /> 24H EMERG�NCY#800-468-1760—CH/SK/TFI—Contract retained by genera11rttor confers agenon cy authori y <br /> On initial t and Or gnbstitute arldition ran15. GENERATOR'SIOFFEROR'S CERTIFIOATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and areclassified,packaged, <br /> marked and labeledtplacarded,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 <br /> Exporter,I car*that the contents of this consignment coMorm to the terms of the attached EPA Acknowledgment of Consent. <br /> I certify that the waste minimization statement identified in 40 CFR 282.27(a)(it I am a large quantity generator (dl am a small quantity generator)is we. <br /> Printed/T ms <br /> s Sig re M� Month Dayq Year <br /> ZL Lv <br /> F 18.IntemMItIrd Shipments LJ Import to U.S. L1 Export him U.S. Pon of enbylexib <br /> ? Transporter signature(for exports only): Date leaving U.S.: <br /> C 17.TrensporerAckn ant of Receipt of Materials <br /> Trensporterl Pd Name SgnaWre Month /Day Year <br /> 2 Tran 'n ed(fyped Name gna Monty Day Year <br /> f ✓) Z <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantify ❑Type ❑Residue ❑Partial Rejection ❑FWI Rejection m <br /> Manifest Reference Number <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> ram Facility's Phore: <br /> w 8 Signature of Ahemate Facility(or Generator) Momh Day Year <br /> Q <br /> 2 <br /> H19.Hara�ouss Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 1. 2. 3. 4. <br /> 20.Designated Facility Owner or Operator:Certifi � n of receipt of h s materials covered by the manifest except a in Item Ise <br /> 1 Sign th Day Year <br /> � <br /> (Rev. <br /> EPA Form <br /> 77801@5 190)_Previous editions are obsolete. DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM <br />