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SSL SK SHTP# 232001264 ,IIIIIIIIIUIII�IIII�'IIII�IIII��N <br /> Please print w type. Form Approved.OMB No.050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3. m R e P 0.Manifest Tracking Number <br /> WASTE MANIFEST 007313798 CAL 000394668 1 '—pt —1 /G0 SKS <br /> 5.Generator's Name and Maili Address Generators Site Address(it different than mailing address) <br /> O' Reilly # X4719 <br /> 15079 S Harlan Rd <br /> LATHROP CA 95330-9802 <br /> Generators Prime: 209-234-1895 <br /> S.Trt"fii' SYSTEMS INC U.S.EPAIDNumbex TY.R011 '05 <br /> 7.Transporter 2 Campari Name U.S.EPA ID Number <br /> CLEAN HARBORS ENV SVC INC. MAD039322'250 <br /> 8.Designated Facility Name and Site Address CLEANHARBORS OF BUTTONWILLOW U.S.EPA ID Number <br /> 2500 LOKERN ROAD <br /> BUTTONWILLOW , CA 93206 <br /> E.61-762-15200 CAD980675276 <br /> Fals Phone: <br /> ga 9b.U.S.DOT Desc ptim(inciud'mg Proper Shipping Name,Hazard Gass,ID Number, 10.CaMMrers 11.Total 12.Unit <br /> HM and Packing Group(if anyp 13.Waste Codes <br /> No. Type Quantity WI-Abl. <br /> 1 fffllh NON—RCRA HAZARDOUS WASTE, SOLID, C DM t P 181 <br /> of o (AHSbRBENT AND OIL), - iso <br /> a � <br /> w <br /> z 2. <br /> w <br /> co <br /> 4 <br /> 14.Special Handling Instructions and Additional Infmnation TSD:BL 83839470 OR16176 <br /> do -70� <br /> 24H EMERGENCY#800-468-1760—CH/SK/TFI—Contract retained by ge:;e rr cc em { y <br /> on initial transporter to add or substitute additional trans orters on eneraornalf. <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,arid are classified,packaged, <br /> marked and abeled/placarded and am in all respects in proper conditim for transport according to applicable international and national governmental regulations.Nexport shipmentand I am the Primary <br /> Exporter,I certify that the contents of this mnsgnment conform 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)(t I am a large quantity generator)or(b)(if I am a small quantity,generator)is true. <br /> GeneratorstONerors Prinledl Name SignaNre Month Day Year <br /> '17 ZZ <br /> J <br /> 16'International Shipments <br /> E ❑Import N U.S. ❑Export from U.S. Pon of entrylexit <br /> ? Transporter signature(for exports only) Date leaving U.S.: <br /> W 17.Transporter Acknowledgment of Receipt of Matenals <br /> QTransporter 1 nledlT Name Sgnature Month Day Year <br /> a <br /> z Tran er PrimadtTyped Name igriatiffe Month Day Year <br /> } 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ ouantity ❑Type ❑Residue ❑PaNal Rejection ❑Fut Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> V <br /> LL <br /> Facility's Phone: <br /> Maj 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> Q <br /> 2 <br /> N19.Hazardgus Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment.dispo,l 1,and recycling systems) <br /> G 1. /�J 2. 3. 4. <br /> 1 20.Designated Owner or Operator Certification otireceipt of hazardous materials covered by the mantest except as road in Item His <br /> Pnntad7T ignaNre Monty ay Wr <br /> EP Fo 1 0, ev4N577d� l editions are obsolete. DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM <br /> )�361;_,,7/ � _, <br />