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SSL SK SHIP# 233074446 1111111111111111111111111111111111111 <br /> 0077685348 K6 <br /> Please print or type. Form Approved,OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1 1.Generator 10 NumberCAL000364385 2.Page 1 of 3. m R s e P 1 0 4.Manifest Tracking Number <br /> 1 �+� <br /> 1007768534WASTE MANIFEST SKS <br /> 5.Generator's Name and Mailing Address Generators Site Address(if different than mailing address) <br /> Autozone # 4036 Autozone # 4036 <br /> 123 South Front Street 3828 E Main St <br /> MEMPHIS TN 38103-0000 . <br /> Generators Phone: 209-463-3374 STOCKTON CA 95215-7 07 <br /> s.Trany�oiler�-CompanuName SYSTEMS INC U.S.EPA ID Number TX R0000B 1205 <br /> 7.Transporter 2YComlppannyy Name U.S.EPA ID Number <br /> CLEAN HARBORS ENV SVC INC. MAD039322250 <br /> 8.Designated Facility Name and Site Address CLEANHARBORS OF BUTTONW I LLOW U.S.EPA ID Number <br /> 2500 LOKERN ROAD <br /> PUTTONWILLOW , GA 93206 <br /> 661-762-6200 CAD980675276 <br /> Facility's Phone: <br /> 9a. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit <br /> HM and Packing Group(if any)) 13.Waste Codes <br /> No. Type Quantity Wt.Nol. <br /> 1. 1g01VE NON-RGRA HAZARDOUS WASTE, SOLIDS I DM J� P 181 <br /> o T , (OILY DEBRIS), W* TJ <br /> z 2. <br /> w <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional Information TSD:BL 84970482 AU32148 CSG. <br /> 24H EMERGENCY#800-468-1760-CH/SK/TFI-Contract retained by generator confers agency authori y <br /> on initial transporter to add or substitute additional transporters ongenerator's behalf. <br /> 15. GENERATOR'S/OFFEROR'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 labeled/placarded,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 contents of this consignment conform to the terms of the attached EPA Acknowledgment 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)(if I am a small quantity generator)is true. <br /> Generator's/ fferors Pnnted/Ty Name Signature Month Day Year <br /> arc t ccs C <br /> 16,International Shipments ❑ <br /> F Import to,t�;6W' ❑Export from U.S. Port of entrylexit: <br /> ? Transporter signature(for exporis only): Date leaving U.S.: <br /> W 17.Transporter Acknowledgment of Receipt of Mate <br /> a p er 1 Pnnted/T Name Signatur Month Day <br /> o O -2 /5 Ye <br /> Z Tr nsporter 2 dnted/Typed Name Si onth Da Year <br /> 18.Discrepanc <br /> 18a.Discrepancy Indication Space El <br /> Quantity El Type ❑Residue Partial Rejection El Full Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> U <br /> LL Facility's Phone: <br /> LJ 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> Q <br /> Z1 <br /> H19.Hazardous Waste Report Management Method Codes(i.e..codes for hazardous waste treatment,disposal,and recycling systems) <br /> LU p 1 \ � 2. 3. 4. <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by t anifest except a noted in Item 18a <br /> Prime pedNa Signatur Month Day Year <br /> I I g <br /> EPA Form 8'-2�71Ryvy�,2 Previous editions are o solete. DESIGNATED FACIL TY TO EPA's e-MANIFEST SYSTEM <br /> 1)864�2� �v X549 <br />