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SK SHIP# 233262277 I VIII I VIII III I IIIIIIII <br /> I I �I IIII III III <br /> 007576880SKS <br /> Please print or type. Form Approved,OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Numbert.At'kry03' c_964 2.Page,1 of 3.Em ; Rs� e F 4.Manifest Tracking Number <br /> WASTE MANIFEST 1007576880 SKS <br /> 5.Generators Name and Mailina Address Generators Site Address(if different than mailing address) <br /> 1200 W Lathrop Rd <br /> KNTEC^ CA 95336-9670 <br /> Generators Phone: 209-239-9606 <br /> 6.Transporterny,Nang SYSTEMS INC U.S.EPA ID Number <br /> 7.Transporter 2 Com any Name U.S.EPA ID Number <br /> C,LE,=1t1 HRHt1RS Eh1U SVC IPar•,. MAD03932250 <br /> 8.Designated Facility Name and Site Address CLEAdHARBORS OF AUTTON14I LL04) U.S.EPA ID Number <br /> 2500 LOKERN ROAD <br /> 6UTTONGJILLOW � CR ?.?_'0E• <br /> 661-7i 2-;5¢'00 CAD`813675276 <br /> Facility's Phone: <br /> ga 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. }s?S E"I_1-N--RCRA HAZARDOUS WASFE, SO 'D, , ^n'' `��. O _ 131 <br /> 0 ?17`'t_':PrENT AND OIL) , NAP t.0_- <br /> w <br /> Z 2. <br /> r, <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional Information TSA BL 35177718 OR 1 @5342 <br /> _24H EMEPiiEtICY4300--468'4760•-CH/SK/TfI-Contract retained by generator^ confers agency authoril v <br /> an initial tr--ansnorter to add or substitute acjdi'-ionai tr,Ln� ,or ter-s on qe; a> .jfr. a <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 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 /> Generators/Offeror's Printed/Typed Name Signature Month Day Year <br /> I Y1 Tctwl a <br /> 16.InfernarbriM Shipments <br /> 1:1 Import to U.S. ❑Export from U.S. Port of entry/exit: <br /> Transporter signature(for exports only): Date leaving U.S.: <br /> W 17.Transporter Ackno Iedgment of Receipt of Materials <br /> LLI <br /> Transporter 1 Printe yped me Signature Month Day Year <br /> Ke <br /> / ��,� <br /> CL <br /> / <br /> Z Transporter rine yped Name <br /> Q M <br /> a Month Day Year <br /> ~ Et <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ I ❑Full Rejection <br /> ❑ Quantity El Type El Residue Partial Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> L) <br /> LL Facility's Phone: <br /> W 18c.Signature ofAltemate Facility(or Generator) <br /> � 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 /> 0 1 14137- 2. <br /> T3. 4. <br /> 20.Designated Facility Owner cir 0 erator:Certification of receipt of hazardous materials covered by the manifest except as2qgguAem f8a <br /> Printed me Month Day Year <br /> EPA Form 87oq,7,2(Rev.12 7), Previous editions are obsolete. SIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM <br />