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SSL SK SHIP# 232337246 �INIUIIIII� I�lII1Nl�'I� <br /> 007766524SK.S <br /> Please pant or type. R Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number CAL000392916 2.Page11 of 3.f1me R go�e 1 200 4.Manifest TmakiNumber <br /> WASTE MANIFEST 1!O 007766824 SKS <br /> 5.Gbirg4fesi y 1 Y d Mailino Addrgss Generatols Site Address if different than mailing address) <br /> 515 E Yoseemite Ave <br /> MANTECA CA 95336-5837 <br /> 209-239-4188 <br /> Geri Phone: <br /> s.TYff ff —WyE-„F9 SYSTEMS INC U.S.EPA ID Number TXR000081205 <br /> 7.Transporter 2 Com an Name U.S.EPA ID Number <br /> CLEAN H�il�BORS ENV SVC INC. MAD039322250 <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 /> 661-762-6200 CAD980675276 <br /> Facility's Phone: <br /> 999b.U.S.DOT Descnption(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 Witt], <br /> 1 -NOME— NON—RCRA HAZARDOUS WASTE, SOLID, DM P 181 <br /> c (ABS <br /> �7RBENT AND OIL), iVlfl O <br /> z z. <br /> w <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional Information TSD:BL 84195367 OR14365 CSG: <br /> 24H EMERGENCY#800-468-1760—CH/SK/TFI—Contract retained by generator confers agency alithori y <br /> on initial transporter to add or substitute additional trans artery on enerator' s behalf. <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contends of this consignment are fully and accurately described above by the proper shipping name,and are dassNed,packaged, <br /> marked and labeled/placarded,and are in all respects in proper condition for transport according to applicable intemafional and national gowntmental regulations.If export shipment and I am the Primary <br /> Exporter,I cenify that the contents of this consignment coni to the terms of the a ched EPAAcknowledgment of Consent. <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I a a large quantity generator)or(b)(if I am small quantity generator)is hue. <br /> Genera% slOffenni Printedryped Name Signature nth Day Year <br /> Jmotional Shipments Ll Import to U.S. ❑Export from U.S. Part of entry/exit: <br /> ? Transporter signature(for exports only): Date leaving U.S.: <br /> W 17.Transporter Acknowledgment of Receipt of Materials <br /> CTra nen 1 Printed(Typed N e Sign Month Day rY�ear <br /> a x}v„� W 09 en d0 <br /> W Trailsr 2 Pnntedrlyped Name Month Day Year <br /> F <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantrty ❑Type ❑Residue ❑Partial RejectionEl lecu <br /> full Re' on <br /> Manifest Reference Number <br /> 18b.Aftemate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> rai Facilitys Phone: <br /> W 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> a <br /> z <br /> y19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) a <br /> C 1. l� /j 2. 3, 4. <br /> 20.Desi alt acility Owner or Operator:Certification ceipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Pnn ed Name J Signature on D9Y r <br /> EPI F}¢ 72ftP6guseditions are obsolete. DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM <br /> j _ <br />