Laserfiche WebLink
{ SSL SKSTHIP# 233070301 <br /> 0077658048KIS <br /> . F s <br /> Form Approved.OMB No,2050-0039 <br /> Please print or type <br /> UNIFORM HAZARDOU5 1.Generator ID Number. CAL000458602 2-Pagell of 3.Em� R9.spep6e d.0I'lli0st�ackiO SKS <br /> WASTE MANIFEST 11 'fLiG if j� 7"9'8"8 <br /> 5.Generators Name and Mailing Address Generator's Sne Andress(if different Nan mailing address) <br /> A & AGas <br /> 1330 E Yosemite Ave <br /> MANTECA CA 95336-0000 <br /> Gen erate rs Phone: 510-396-5560 1 �0 <br /> 6.Tr�rWcJl.Con n� SYSTEMS INC Ii EPA ID Numbar TXR000081205 <br /> 7.TranspoAer 2 Com an Name U.S.EPA ID Number <br /> CLEAN HIftY80R5 ENV SVC INC. MAD039322250 <br /> e.Designated Facility Name and Site Address CLEAN HARBORS GRASSY MOUNTAIN US EPAIDNumber <br /> 3 MILES EAST, 7 MILES NORTH KNOLLS EXIT 41, OFF I-80 <br /> KNOLLS , UT 84083 <br /> +r. 435-884-8915 UTD9913$1748 <br /> FacilillIs Phone: <br /> ga 9h.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers31.Total 12.Unit 13-Waste Codes <br /> HM and Packing Grou it any]] p., No., Type Quantity WINcL <br /> 1. ON—RCRA HAZARDOUS WASTE, SOLIDS nM <br /> p I L, DIRT, SAND BSORBENTS AND <br /> a 6TESEL FUEL), <br /> x 2. <br /> w <br /> c� <br /> B . <br /> A <br /> 4- <br /> rr <br /> 14.Special Handling Instructions and Add tional Information TSD;GM 649578422 AA 13145 CSG. <br /> 24H EMERSENCY#800-468-1760--CH/SK/TFI—Contract retained by generator confers agency authori y <br /> on initial transporter to add or substitute additional transporters on enerafur's behalf. <br /> 15. GEN ERATOR'S10FFEROR'S CERTIFICATION:I hereby declare that the contents of this consignment are fully and aocurai described above by the proper shipping name,are are classified,packaged, <br /> marked and labeeedlparcarded,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 certify that the oonteols of this consignment mrlonm to the terms of the attached EPAAcknmvledgment of Consent, <br /> I certify that the waste minimizafion statement identified in 40 CFR 26227(a)(if I am a Targe quantity generator)or(b)(f I am a small quantity generator)is true. <br /> Generator'sfOBerors Printedf77yped Name Signature Month Day Year <br /> 16.International Shipments <br /> I ❑Import to U.SF ❑ from U.S.froU.S. Port ofentyrexit <br /> ? Transporter signature(for exports unry): Date leaving U.S.: <br /> ce 17,TransporterAdmowledgwent ofReceipt ofMaterials <br /> Ljj <br /> Tran rte 1 PrinIsC d Na a Tx� Signature - Month Day Year <br /> Z4 <br /> eL lin G� I <br /> Tm spoiler 2 Prin daype aAQSignature M <br /> 10.Discrepancy <br /> 18a.Discrepancy Indication Space <br /> ❑Quantity ❑Type Residue ❑Partial Rejetlion ❑Full Rejection <br /> Manifest Reference Number: <br /> 106.Alternate Facility(or Generator} U.S-EPA 1D Number <br /> J <br /> U <br /> Facility's Phone: <br /> ?�` w 18c.Signature ofAhemate Facility tor Generator) Month Day Year <br /> z � � <br /> 19.1Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recyrAing systemst <br /> - O 1 -/7-� 2. <br /> /� r <br /> 20-Designated Facility Owner or Operator.CerOFication at receipt of hazardous materials covered by I manifest except as noted in Item fact l(� <br /> Pri IedR e me ^ - Signature J�MMonth Day Year <br /> EPiCoArA <br /> 17�1TL 2revious editions are obsolete.. DESIGNA ED FAULITY TO EPA's 9-MANIFEST SYSTEM <br /> S7 t3 1 46fSlp <br /> L -. r+ek '". -� ^Ta�^.�al_.-:�x �.... �i x'�:."'°"�'p:a-+e�.�.r^>r,_.e+m ^.�.�-.s�..•aa-.gym. �- <br />