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SK SHIP# 233777390 <br /> rmwo print or type. Form Approved.OMB No.2050-0039 <br /> 4.Manifest Tracking Number <br /> 1.Generator ID Number 2.Pa 3.f-mM"FgqAA lfl?reo <br /> UNIFORM HAZARDOUS CAL00101394 <br /> WASTE MANIFEST I � 007577476 SKS <br /> 5.�!prj andlaili ss Generators Site Address(if different than mailing address) <br /> ff,079 S Harlan Rd <br /> L0,THROP CA 95330-9802 <br /> Generators Phone: 209-234-1895 <br /> ,_,f SVSTEMS INC T X R0101008 12205 <br /> 1.Tret%'9396WS ENV SVC INC. U.S.EPA to Number MAD039322250 <br /> 8.Designated Facility Name and Site Address CLEAN HARBORS ARA NITE, LLC U.S.EPA ID Number <br /> 11600 NORTH APTUS ROAD <br /> 435-384-8100 ARAGONITE UT 64029 UlD961552177 <br /> Facility's Phone: I <br /> 9a. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes <br /> HM and Packing Group(if any)) No. Type Quantity Wt.Nol. <br /> X 1. RU LIN 1993 WASTE FLAMMABLE LIGUIDS DM too F-0-01 F002 F003 <br /> (DO61. F007, D001 22-3 <br /> LU <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional Information ISO:A133 851e3e47' <br /> 24H EMERG�NCY#aoo-468-1760—CH/SK/TFI—Contract retained by generator confers agency <br /> > <br /> / <br /> | <br /> � <br /> | <br /> / <br /> / <br /> � <br /> ` <br /> y <br /> an initial tr-ansporter to add or substitute additional transporters on generator' s behalf.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.r Generator's/Offerors Printed lye Name Signature onth Day Year � <br /> _j 16.Intimational Shipments <br /> 1— 171 Import to U.S. Export from US. o��- Port of entry/exit: <br /> Z Transporter signature(for exports only): Date leaving U.S.: <br /> 1X 17,Transporter Acknowledgp�t of Receipt of Materials <br /> LU <br /> Transporter 1 Printed[Typ "Name Signal re Month Day Year <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space D Quantity El Type El Residue Partial Rejection Full Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> Facility's Phone: <br /> LL, 18c,Signature of Alternate Facility(or Generator) Month Day Year <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> dAJA, ( Iq I <br /> 0 A11-1 <br /> EPAfonRNM%A17 revious e)itions are obsolete. DESIGNATE�LITY TO EPA's e-MANIFEST SYSTEM <br /> | <br /> ' <br /> ' <br /> | <br /> ' <br /> � <br />