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SSL SK SHIP# 232182669 1111111111111111111 <br /> 0 0 7 7 7 1 3 3 0 S K S <br /> Please pnnt or type. Forrn Approved.OMB NO.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number CAL000393335 2.Page11 of 3.€ '1M0 4.ManNest Tracking Number <br /> WASTE MANIFEST 1007771350 SKS <br /> 5,GUS K21L r f ynand EEailigI ff gss Generator's Site Address(if different than mailing address) <br /> 1551 W Main St <br /> RIPON CA 95366-3012 <br /> Generators Phare: 972-555-1640 <br /> 6'T3WVVggKtt& SYSTEMS INC U.S.EPA ID Number TXR000081205 <br /> 7.Trytysfra A' r OS ENV SVC INC. U.S.EPA ID Number MA�93222W <br /> 8.Designated <br /> ddFacility Rama and Site Address CLEANHARBURS W BtJTTONWILLOW U.S.EPA ID Number <br /> 2500 LOKERN ROAD <br /> BUTT�)ILLOW , CA 93206 <br /> 661-762-6200 CAD980675276 <br /> Facility's Phone: <br /> ga 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unci <br /> HM and P Group('rf any)) 13.Waste Cedes <br /> No. Type Quantity WtNol. <br /> MILM-11LIKH HALAFIDOLIS WASTE, SOLID, <br /> DM P 181 <br /> o (ABSEIRBENT AND OIL), *144- <br /> 2. <br /> W <br /> 3. <br /> I <br /> 4. <br /> 14.Special Handling Instructions and Additional Informal p <br /> aoo�2 <br /> 24H EMERGENCY#800-468-1760-CH/SK/TFI-Contract retained by generator confers a ency authori y <br /> on initial transporter to add or substitute additional transporters on generator's behalf. <br /> 15. GENERATOR'SIGFFEROR'S CERTIFICATION: I hereby declare that the conlerds 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 ail respects in paper condition fur transport according to applicable international and national go mmmenral regulations.0 export shipment and I am the Primary <br /> Exporter,I certify,that the contents of NS consignment conform to the terms of the attached EPA Acknowledgment of Consent. <br /> Ica"Nat Ne waste minimization statement identified in 40 CFR 262.27(a)(it I am a large quantitygenerator)or(b (dl am a small quantity generates)is We. <br /> GerreratoeslOfferil Printedrryped Name Signals, Month Day Year <br /> O$ I 1-% I 10 <br /> 16.linternalli Shipmerts <br /> F ❑Import to U.S. ❑Expon from U.S. Pon of entryledt: <br /> ? Transporter signature(for exports only): Date leaving U.S.: <br /> C 17.Transpa[erPdmowl00gment of Receipt of Materials <br /> TrIiiisporter 1 PnmedRype/�f,Name �s S' Month Day Year <br /> 018 pDaoZc1 <br /> i Transporter 2 Pnntecirryped Name lure Mond Day Year <br /> CW1u zJ <br /> * 18.Discrepancy <br /> laa.Discrepancy Indication Space ❑ Qsumpy ❑Type ❑Residue ❑Parb.l Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> 18b.Altemate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> V <br /> LL Facility.Phare: <br /> Mua 18c.Signature ofAaemale Facility(or(3enerator) Month Day Year <br /> Q <br /> H19.H rdous 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 Ovmer or Operator cation of receipt of materials covered by the nifest except as noted in Item 18a <br /> Pnn Name , gretu Dai Year <br /> \ o <br /> EPA� t, - Zus editions are obsolete. I DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM <br />